Latissimus Dorsi Tendon Reconstruction at the Myotendinous Junction With Acellular Dermal Allograft

Background: Limited available data have shown latissimus dorsi tendon reconstruction to be an effective treatment for tendon tears in specific subpopulations of elite overhead throwing athletes. Indications: Primary indication for latissimus dorsi tendon reconstruction is a symptomatic, full-thickness humeral avulsion with or without a concomitant teres major tendon tear. Surgical candidates are typically young, high-demand, elite or professional overhead throwing athletes. In this case, the patient is a 29-year-old male former minor league pitcher and current pitching coach with a full-thickness avulsion of the latissimus dorsi tendon. Technique Description: The patient was positioned left lateral decubitus with a dynamic limb positioner maintaining the arm in 90° abduction and maximal internal rotation. This technique used a single posterior axillary incision, which was performed and dissected down to the ruptured latissimus dorsi tendon. We circumferentially applied an acellular dermal allograft to augment the reconstruction at the myotendinous junction. Subsequently, the construct was prepared for transfer with a Krackow suture technique. Suture buttons were used to secure the reconstructed latissimus dorsi tendon to the anatomic footprint on the proximal humerus with a tension slide technique. Results: One case series showed return to the previous level of competition for all baseball pitchers who underwent a latissimus dorsi reconstruction with excellent improvement in visual analog scale pain, American Shoulder and Elbow Surgeons, and Kerlan-Jobe Orthopaedic Clinic scores. Another larger study demonstrated equal return to play rates for professional baseball pitchers with a latissimus dorsi tear treated either nonoperatively or operatively. However, those treated operatively had no decline in performance, whereas the nonoperative cohort saw decline in some statistics. Conclusion: Latissimus dorsi tendon reconstruction using an acellular dermal allograft at the myotendinous junction is a viable treatment option for elite overhead throwing athletes with full-thickness tendon avulsions. It allows for full return to play, particularly if the patient has failed nonoperative management.

Surgery for fibroadenoma arising from axillary accessory breast

Background Patients with fibroadenomas in axillary accessory breasts (AABs) have a palpable mass, cyclic axillary pain, and aesthetic concerns that must be addressed. We compared the baseline patient characteristics, AAB characteristics, and surgical outcomes of patients with AABs with and without fibroadenomas undergoing surgical excision. We also monitored the patients for recurrence of axillary fibroadenomas. Methods This retrospective study involved 2310 women who underwent AAB excision from 2014 to 2019. Patients with and without a palpable fibroadenoma were divided into a fibroadenoma group and non-fibroadenoma group, respectively. All patients underwent complete excision of accessory mammary gland (AMG) tissue, including fibroadenomas in the AABs. We removed the fibroadenoma and the AMG tissue with a minimal axillary incision. Results Thirty-nine patients had a palpable fibroadenoma in the AAB, and all patients in the fibroadenoma group had cyclic axillary pain and a palpable axillary mass. There were no significant differences in the patients’ age, weight of the AMG tissue, liposuction volume, or fibroadenoma laterality between the two groups. The body mass index in the fibroadenoma group was lower than that in the non-fibroadenoma group (19.9 vs. 22.3 kg/m2, respectively; P < 0.000). Concurrent fibroadenoma excision in a normal breast on the chest was performed more often in the fibroadenoma group than in the non-fibroadenoma group (35.9% (14/39) vs. 4.1% (92/2271), respectively; P < 0.000). The mean fibroadenoma size was 2.1 cm (range, 1.1–9.1 cm). All patients were satisfied with the degree of postoperative pain relief, disappearance of palpable lesions, and cosmetic improvement. No patients developed fibroadenoma recurrence. Conclusions Complete excision of the AMG tissue and fibroadenoma is appropriate in patients with an AAB with a fibroadenoma. Surgeons should also consider the high incidence of concurrent fibroadenomas in the normal breasts on the chest.

Application of Left Axillary Incision in Patent Ductus Arteriosus Ligation

Background: Left posterolateral incision has been a conventional incision for patent ductus arteriosus ligation. This study aimed to evaluate the efficacy and safety of left axillary thoracotomy for patent ductus arteriosus ligation. Methods: Between January 2013 and December 2019, the clinical data of 76 patients who underwent left axillary thoracotomy for patent ductus arteriosus ligation were compared with the data of a paired group of 101 patients who underwent left posterolateral thoracotomy. Results: Compared with the left posterolateral group, the left axillary group showed less drainage (P < 0.05). Operation time, postoperative mechanical ventilation time, and postoperative hospitalization duration were similar between the groups. Complications were rare in both groups with no mortality during follow up. In total, 72 patient families (95%) in the left axillary group and 81 patient families (80%) in the left posterolateral group were satisfied with their cosmetic results (P < 0.01). Conclusions: A left axillary thoracotomy is as safe and effective as a left posterolateral thoracotomy for patent ductus arteriosus ligation. With lower trauma and better cosmetic results, this procedure provides a good alternative to the standard left posterolateral thoracotomy.

The Clinical Application of Novel Mini Transoral Endoscopic Thyroidectomy to Avoid Numbness and Pain in Patients with Thyroidectomy

Background: Transoral endoscopic thyroidectomy has been gaining popularity as it allows patients to avoid a visible scar in the neck. However, there are still exiting disadvantages of traditional transoral endoscopic thyroidectomy，including numbness in the lower jaw or excessive edema. Therefore, we designed and applied a novel Mini transoral endoscopic thyroidectomy on patients requiring for thyroidectomy.Patients and Methods: A total of 55 patients requiring for unilateral thyroidectomy who underwent novel Mini transoral endoscopic thyroidectomy (Mini group) were identified from August 2019 to December 2019. As a comparison, a matched cohort of 55 patients requiring for conventional transoral endoscopic thyroidectomy was also identified. The two groups were analyzed in terms of clinical characteristics, perioperative/operative clinical date and post-operative complications. Results: The hospitalization time of patients in the Mini group was obviously less than that in traditional group. Furthermore, the numbness of the lower jaw, nylon wire examination score, pressure needle puncture examination score, or numbness VAS score indicated that the degree of numbness of the jaw in Mini group is significantly better than the traditional group. Moreover, the pain of the axillary incision using the pain VAS score method also showed that Mini group is significantly better than the traditional group. The results of pain of the axillary incision using the VAS score method also showed that novel Mini group was significantly better than that in the traditional group. Furthermore, dysfunction of mandibular muscles was observed in six of fifty-five patients in the traditional group, whereas no dysfunction of mandibular muscles observed in Mini group. At last, the degree of postoperative mandibular edema in Mini group was markedly slighter than that in traditional group. The post-operation infection rate was markedly lower in Mini group.Conclusion: The new novel Mini transoral endoscopic thyroidectomy is safe and feasible, and reduces the damage to the functional muscles such as the mandibular diaphragm and lower lip muscles, which significantly reduces the numbness and edema of the mandible after surgery. Our novel Mini transoral endoscopic thyroidectomy is a feasible and safe advancement, which can be a viable alternative protecting patients from insufferable numbness and pain.