Background:Soft tissue reconstruction is typically conducted after evacuation from theater of operations.If circumstances do not allow timely evacuation,however,defect site may need to be reconstructed in the combat z...Background:Soft tissue reconstruction is typically conducted after evacuation from theater of operations.If circumstances do not allow timely evacuation,however,defect site may need to be reconstructed in the combat zone.Case presentation:A total of 41 patients with extremity soft tissue defect were treated using pedicled flaps by a single orthopedic surgeon during four deployments in Chad,Afghanistan and Mali between 2010 and 2017.The mean age was 25.6 years.A total of 46 injury sites in extremities required flap coverage:19 combat-related injuries(CRIs)and 27 non-combat related injuries(NCRIs).Twenty of the injury sites were infected.Overall,63 pedicled flap transfers were carried out:15 muscle flaps,35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps.The flap types used did not differ for CRIs or NCRIs.Mean follow-up was 71 days.Complications included deep infection(n=6),flap failure(n=1)and partial flap necrosis(n=1).Limb salvage rate was 92.7%(38/41).Conclusions:Soft tissue defect can be managed with simple pedicled flaps in theatre of operations if needed.Basic reconstructive procedures should be part of the training for military orthopedic surgeons.Trial registration:Retrospectively registered in January 2019(2019-0901-001).展开更多
AIM:To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis.METHODS:This ...AIM:To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis.METHODS:This study was per formed as a retrospective analysis of patients who received conjunctival dacryocystorhinostomy with pedicled conjunctival flap reconstruction combined with tube intubation due to severe superior and inferior lacrimal canalicular obstruction with conjunctivochalasis from January 2019 to October 2019.The clinical data included the degree of preoperative epiphora and postoperative relief,preoperative examination of lacrimal duct computed tomography and ultrasound biomicroscopy,postoperative evaluation of lacrimal duct function by chloramphenicol taste and fluorescein dye disappearance test,etc.Syringing was carried out to determine the reconstruction and patency of the lacrimal duct.RESULTS:All 9 patients(9 eyes)had severe canalicular obstruction with conjunctivochalasis.The patients included 4 males and 5 females aged between 47–65y with an average age of 52.2±6.7y.At 3mo follow-up,the tube was removed and the patients were followed for a further 3mo.After tube removal,6 patients showed no epiphora.These patients also had positive chloramphenicol tastes and normal fluorescein dye disappearance test results.Two patientshad epiphora.Also,syringing showed partial patency of the reconstructed lacrimal duct.One patient had no improvement in epiphora with negative chloramphenicol taste and fluorescein dye disappearance test results and obstruction of the reconstructed lacrimal duct.The total effective rate of the operation was 8/9,with no serious complications.CONCLUSION:Pedicled conjunctival lacrimal duct reconstruction conjunctival dacryocystorhinostomy is safe and effective for superior and inferior canalicular obstruction with conjunctivochalasis.展开更多
The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experienc...The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experience with the PMMF in head and neck reconstruction. One hundred and two patients who underwent the PMMF technique were reviewed on the clinical records. Postoperative complications were classified into flap loss, hemorrhage, infection, fistula formation, wound dehiscence and donor site complication. Eighty two patients (80.4%) demonstrated no complication. Six patients among 102 patients (5.9%) demonstrated total or partial skin necroses. Three female patients were completely dissatisfied with the cosmetic appearance after the PMMF. One of them required a reconstructive surgery with the latissimusdorsi flap. Without surgical expertise in plastic surgical field, an ear-nose-throat or an oral surgeon can performed the PMMF technique provided the operator is well aware of serious and frequent complications of this “workhorse” procedure.展开更多
BACKGROUND： Translocation or transplantation of nerve stem has good effect; however, nervous function of donator is completely lost. If some nerve stem is damaged, sensory tracts are intercepted from the near nerve s...BACKGROUND： Translocation or transplantation of nerve stem has good effect; however, nervous function of donator is completely lost. If some nerve stem is damaged, sensory tracts are intercepted from the near nerve stem by nutrient vessels to regard as neural graft for transferring and bridging which may repair injured nerve and decrease neural functional loss of donator. OBJECTIVE： To observe anatomical peculiarities on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect, and to investigate its feasibility. DESIGN：Duplicated and measured design.SETTING ： Anatomy Department of Medical College affiliated to Nanhua University.MATERIALS： A total of 14 samples of upper limbs were selected from adult unnamed corpse and volunteers.METHODS： The experiment was completed at the Clinical Application Anatomy Laboratory of Medical College affiliated to Nanhua University from September to November 2005. Samples were perfused with red emulsion through artery to observe length, fibrous bands and blood supply of median nerve and ulnar nerve at wrist. Boundary of median nerve at wrist ranged from superficial site between flexor carpi radialis and palmaris Iongus to branch of common palmar digital nerves. Ulnar nerve at wrist ranged from branch of back of the hand to site of common palmar digital nerves. Proximal boundary of the two nerves was crossed from 1/8 to 2/8 region of forearm. Samples of upper limbs from 1 case were selected to simulate operation on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve. MAIN OUTCOME MEASURES： Anatomical peculiarities on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect. RESULTS： ① The length of wrist median nerves was 7.8 （7.5-8.1） cm. There were 19 to 27 nerve tracts in it and the majority belonged to sensory tracts on the ulnar side, in which non-damaged separated length was about 10.0 cm to 14.0 cm. The third, second and first tracts of cutaneous branches at digital interspace and radialis of thumb arrayed from ulnaris to radialis by turns, and numbers of bands were 6.9, 7.4 and 7.2, respectively. The bands in total were 21.6. Cutaneous branches of palm entered from lateral margin of radialis and were completely separated at wrist. Two-thirds of ulnaris at nerve stem, i.e. the third, second and first tracts of cutaneous branches at digital interspace, were separated, which had little effect on sensation in distribution of median nerve. ② Its nutrient vessels originated from radial arteries about 6.2 （6.1-6.6） cm above radial styloid process were 1.2 （1.1-1.4） mm in outer diameter. The length was 5.7 （5.1-6.1） cm.③ The length of wrist ulnar nerve were 9.4 （8.9-9.7） cm and the number of nervous tract were 14 to 19, in which sensory tracts on the anterior external side were approximately equal to motor and mixed tracts on the posterior internal side in quantity. Sensory tracts were located at radialis of palm and motor tracts were located at ulnaris of back. CONCLUSION ：① Character and position of median nerve fibre bundle are clear, and length of non-damage separation of sensory tracts is coincidence with the request of transferring to bridge. ② Summation of the third, second and first tracts of cutaneous branches at digital interspace may be satisfactory to bridge of ulnar nerve at wrist （14-19 bands）. ③ This technique has little effect on sensation in distribution of median nerve. Nutrient artery of median nerve locates constantly; journey table is superficial and is easily to find out; caliber of arterial canal is thick; blood supply is plentiful; length of pedicel is suitable for translocation. The sensery tracts of wrist median nerve pedicled with nutrient vessels can be applied as nervous grafts to join injured gap in wrist ulnar nerve.展开更多
The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evo...The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.展开更多
Background Through precise understanding of the vascular anatomy of the breast,the lower segment of the breast could be harvested as a pedicled or free flap for contralateral breast reconstruction.Case presentation In...Background Through precise understanding of the vascular anatomy of the breast,the lower segment of the breast could be harvested as a pedicled or free flap for contralateral breast reconstruction.Case presentation In case 1,based on the 4th internal thoracic artery perforator,the pedicled flap from the breast was transferred to the contralateral side for immediate breast reconstruction.In case 2,with the thoracoacromial vascular pedicle,the free flap from the healthy breast was harvested for delayed breast reconstruction on the contralateral side.Results Both flaps survived well postoperatively.A certain degree of asymmetry was observed in both cases,but the patients were satisfied with the overall results.At the end of follow-up,no tumor recurred in either breast.Conclusion In patients with a large healthy breast,the lower segment could be harvested as a pedicled or free flap for contralateral breast reconstruction.展开更多
Objective To study feasibility and value of repair of oral mandibular defects with rib composite flap pedicled with internal thoracic vessels in basic level hospitals. Methods The clinical materials in 13 cases uith m...Objective To study feasibility and value of repair of oral mandibular defects with rib composite flap pedicled with internal thoracic vessels in basic level hospitals. Methods The clinical materials in 13 cases uith mandibular defects which were repaired with rib compos-展开更多
Objective To evaluate the effect of wound closure tension on the blood flow of the expanded pedicled fasciocutaneous flap,so as to find the best tension for the blood supply of the flap.Methods 8 piglets,aged 9-12 mon...Objective To evaluate the effect of wound closure tension on the blood flow of the expanded pedicled fasciocutaneous flap,so as to find the best tension for the blood supply of the flap.Methods 8 piglets,aged 9-12 months,were used.On展开更多
To provide anatomic basis for transposition of vascularized radial midforearm flap.Methods On 40 adult cadaveric upper limb specimens injected with red dye,the origin,course,branchs,diameters and anastomosis of interm...To provide anatomic basis for transposition of vascularized radial midforearm flap.Methods On 40 adult cadaveric upper limb specimens injected with red dye,the origin,course,branchs,diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed.Results Originating from radial artery,intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator,the main stem was (4.8±1.0)cm in length and (1.2±0.2)mm in diameter.After its periosteal branches were sent off to distribute over middle and inferior shaft of radius,its cutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm.Perforating point of the cutaneous branch was located (11.1±1.3)cm beneath lateral epicondyle of humerus,its diameter was about (0.6±0.1)mm.Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow,forearm or hand.7 refs.展开更多
Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 200...Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle展开更多
To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March ...To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.展开更多
Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidi...Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.展开更多
Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing...Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing has traditionally relied on arbitrary timing or subjective measures.This study explores the use of indocyanine green(ICG)angiography in the office setting as an objective guide for timing the delayed pedicled flap pedicle division,aiming to improve surgical outcomes and resource efficiency.In the outpatient setting,ICG is administered intravenously while the flap pedicle is under tourniquet control.If the distal flap opacifies with the tourniquet still applied,appropriate revascularization has occurred,and the pedicle may be safely divided.We present the example of a 47-year-old male with multiple previous flap reconstructions who eventually required a reverse sural artery flap.Initial intraoperative ICG imaging on postoperative day(POD)23 revealed insufficient perfusion,prompting the postponement of pedicle division.Subsequent office-based imaging on POD 47 revealed a persistent lack of neovascularization.Adequate vascularization was demonstrated on POD 81,enabling successful pedicle division in the operating room on POD 121 without complications.ICG fluorescent angiography can guide the timing of division for delayed pedicled flaps.We recommend its use in the outpatient setting to decrease unnecessary operating room usage and anesthetic events and reduce the risk of wound healing complications from early pedicle division.展开更多
Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-co...Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.展开更多
Purpose:Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of ...Purpose:Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb;a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice.Methods:A retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making.Results:Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1-80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%).Conclusion:The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.展开更多
Background: In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could b...Background: In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised. Case presentation: We report the case of a patient with full thickness burns on both legs, leading to the exposure of joints of the right ankle and the right foot and left patellar tendon. The right lower extremity was covered with a free musculo-cutaneous latissimus dorsi flap. Then, a musculo-cutaneous cross-leg flap pedicled on the anterior branch and centered on a perforator was harvested from the previous redundant flap to cover the controlateral knee. Conclusion: Sequential flap coverage can be considered in cases of extensive soft tissue defects and particularly in burns. This case illustrates that re-using a redundant part of a previous flap to cover another defect is a safe and interesting alternative in the event of a lack of donor sites or to save donor sites for later reconstruction of contracted burn scars.展开更多
Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system resources.Curre...Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system resources.Current trends in the United States heavily favor the use of free tissue transfer over locoregional pedicles flaps(LRPF);however,the latter group is often undervalued,offering high utility,practicality,and cost-efficiency whilst providing equivalent results.The submental island flap and supraclavicular artery island flap are two LRPF that should be in the arsenal of the modern reconstructive surgeon.展开更多
In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recover...In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robotassisted hepatectomy(RAH) has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the longterm efficacy of both LH and RAH.展开更多
BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation...BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation failure is poor bone quality.On the other hand,some evidence suggests that surgical tactics can influence long-term instrumentation stability.AIM To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.METHODS This study is a non-randomized single center ambispective evaluation of 204 consecutive patients(117 men;87 women)with unstable thoracolumbar injuries.All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation.In cases with spinal cord and nerve root injuries,either posterior or anterior decompression were performed.Patients with pedicle screw loosening were identified via computed tomography imaging.Out of those,cases with clinically significant instrumentation failure were registered.RESULTS The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels,residual kyphotic deformity,laminectomy,and lumbosacral fixation.Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development.Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk,while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure.Anterior decompression does not have a negative impact on instrumentation stability.CONCLUSION Intermediate screws,anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development.Posterior fusion is beneficial in terms of instrumentation failure prevention.展开更多
文摘Background:Soft tissue reconstruction is typically conducted after evacuation from theater of operations.If circumstances do not allow timely evacuation,however,defect site may need to be reconstructed in the combat zone.Case presentation:A total of 41 patients with extremity soft tissue defect were treated using pedicled flaps by a single orthopedic surgeon during four deployments in Chad,Afghanistan and Mali between 2010 and 2017.The mean age was 25.6 years.A total of 46 injury sites in extremities required flap coverage:19 combat-related injuries(CRIs)and 27 non-combat related injuries(NCRIs).Twenty of the injury sites were infected.Overall,63 pedicled flap transfers were carried out:15 muscle flaps,35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps.The flap types used did not differ for CRIs or NCRIs.Mean follow-up was 71 days.Complications included deep infection(n=6),flap failure(n=1)and partial flap necrosis(n=1).Limb salvage rate was 92.7%(38/41).Conclusions:Soft tissue defect can be managed with simple pedicled flaps in theatre of operations if needed.Basic reconstructive procedures should be part of the training for military orthopedic surgeons.Trial registration:Retrospectively registered in January 2019(2019-0901-001).
基金Supported by Dalian Medical Science Research Project (No.1811048)。
文摘AIM:To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis.METHODS:This study was per formed as a retrospective analysis of patients who received conjunctival dacryocystorhinostomy with pedicled conjunctival flap reconstruction combined with tube intubation due to severe superior and inferior lacrimal canalicular obstruction with conjunctivochalasis from January 2019 to October 2019.The clinical data included the degree of preoperative epiphora and postoperative relief,preoperative examination of lacrimal duct computed tomography and ultrasound biomicroscopy,postoperative evaluation of lacrimal duct function by chloramphenicol taste and fluorescein dye disappearance test,etc.Syringing was carried out to determine the reconstruction and patency of the lacrimal duct.RESULTS:All 9 patients(9 eyes)had severe canalicular obstruction with conjunctivochalasis.The patients included 4 males and 5 females aged between 47–65y with an average age of 52.2±6.7y.At 3mo follow-up,the tube was removed and the patients were followed for a further 3mo.After tube removal,6 patients showed no epiphora.These patients also had positive chloramphenicol tastes and normal fluorescein dye disappearance test results.Two patientshad epiphora.Also,syringing showed partial patency of the reconstructed lacrimal duct.One patient had no improvement in epiphora with negative chloramphenicol taste and fluorescein dye disappearance test results and obstruction of the reconstructed lacrimal duct.The total effective rate of the operation was 8/9,with no serious complications.CONCLUSION:Pedicled conjunctival lacrimal duct reconstruction conjunctival dacryocystorhinostomy is safe and effective for superior and inferior canalicular obstruction with conjunctivochalasis.
文摘The pectoralis major myocutaneous pedicle flap (PMMF) is still being used by many surgeons and plays an important role in head and neck reconstruction. The purpose of this series was to review our 10 years’ experience with the PMMF in head and neck reconstruction. One hundred and two patients who underwent the PMMF technique were reviewed on the clinical records. Postoperative complications were classified into flap loss, hemorrhage, infection, fistula formation, wound dehiscence and donor site complication. Eighty two patients (80.4%) demonstrated no complication. Six patients among 102 patients (5.9%) demonstrated total or partial skin necroses. Three female patients were completely dissatisfied with the cosmetic appearance after the PMMF. One of them required a reconstructive surgery with the latissimusdorsi flap. Without surgical expertise in plastic surgical field, an ear-nose-throat or an oral surgeon can performed the PMMF technique provided the operator is well aware of serious and frequent complications of this “workhorse” procedure.
文摘BACKGROUND： Translocation or transplantation of nerve stem has good effect; however, nervous function of donator is completely lost. If some nerve stem is damaged, sensory tracts are intercepted from the near nerve stem by nutrient vessels to regard as neural graft for transferring and bridging which may repair injured nerve and decrease neural functional loss of donator. OBJECTIVE： To observe anatomical peculiarities on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect, and to investigate its feasibility. DESIGN：Duplicated and measured design.SETTING ： Anatomy Department of Medical College affiliated to Nanhua University.MATERIALS： A total of 14 samples of upper limbs were selected from adult unnamed corpse and volunteers.METHODS： The experiment was completed at the Clinical Application Anatomy Laboratory of Medical College affiliated to Nanhua University from September to November 2005. Samples were perfused with red emulsion through artery to observe length, fibrous bands and blood supply of median nerve and ulnar nerve at wrist. Boundary of median nerve at wrist ranged from superficial site between flexor carpi radialis and palmaris Iongus to branch of common palmar digital nerves. Ulnar nerve at wrist ranged from branch of back of the hand to site of common palmar digital nerves. Proximal boundary of the two nerves was crossed from 1/8 to 2/8 region of forearm. Samples of upper limbs from 1 case were selected to simulate operation on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve. MAIN OUTCOME MEASURES： Anatomical peculiarities on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect. RESULTS： ① The length of wrist median nerves was 7.8 （7.5-8.1） cm. There were 19 to 27 nerve tracts in it and the majority belonged to sensory tracts on the ulnar side, in which non-damaged separated length was about 10.0 cm to 14.0 cm. The third, second and first tracts of cutaneous branches at digital interspace and radialis of thumb arrayed from ulnaris to radialis by turns, and numbers of bands were 6.9, 7.4 and 7.2, respectively. The bands in total were 21.6. Cutaneous branches of palm entered from lateral margin of radialis and were completely separated at wrist. Two-thirds of ulnaris at nerve stem, i.e. the third, second and first tracts of cutaneous branches at digital interspace, were separated, which had little effect on sensation in distribution of median nerve. ② Its nutrient vessels originated from radial arteries about 6.2 （6.1-6.6） cm above radial styloid process were 1.2 （1.1-1.4） mm in outer diameter. The length was 5.7 （5.1-6.1） cm.③ The length of wrist ulnar nerve were 9.4 （8.9-9.7） cm and the number of nervous tract were 14 to 19, in which sensory tracts on the anterior external side were approximately equal to motor and mixed tracts on the posterior internal side in quantity. Sensory tracts were located at radialis of palm and motor tracts were located at ulnaris of back. CONCLUSION ：① Character and position of median nerve fibre bundle are clear, and length of non-damage separation of sensory tracts is coincidence with the request of transferring to bridge. ② Summation of the third, second and first tracts of cutaneous branches at digital interspace may be satisfactory to bridge of ulnar nerve at wrist （14-19 bands）. ③ This technique has little effect on sensation in distribution of median nerve. Nutrient artery of median nerve locates constantly; journey table is superficial and is easily to find out; caliber of arterial canal is thick; blood supply is plentiful; length of pedicel is suitable for translocation. The sensery tracts of wrist median nerve pedicled with nutrient vessels can be applied as nervous grafts to join injured gap in wrist ulnar nerve.
文摘The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.
文摘Background Through precise understanding of the vascular anatomy of the breast,the lower segment of the breast could be harvested as a pedicled or free flap for contralateral breast reconstruction.Case presentation In case 1,based on the 4th internal thoracic artery perforator,the pedicled flap from the breast was transferred to the contralateral side for immediate breast reconstruction.In case 2,with the thoracoacromial vascular pedicle,the free flap from the healthy breast was harvested for delayed breast reconstruction on the contralateral side.Results Both flaps survived well postoperatively.A certain degree of asymmetry was observed in both cases,but the patients were satisfied with the overall results.At the end of follow-up,no tumor recurred in either breast.Conclusion In patients with a large healthy breast,the lower segment could be harvested as a pedicled or free flap for contralateral breast reconstruction.
文摘Objective To study feasibility and value of repair of oral mandibular defects with rib composite flap pedicled with internal thoracic vessels in basic level hospitals. Methods The clinical materials in 13 cases uith mandibular defects which were repaired with rib compos-
文摘Objective To evaluate the effect of wound closure tension on the blood flow of the expanded pedicled fasciocutaneous flap,so as to find the best tension for the blood supply of the flap.Methods 8 piglets,aged 9-12 months,were used.On
文摘To provide anatomic basis for transposition of vascularized radial midforearm flap.Methods On 40 adult cadaveric upper limb specimens injected with red dye,the origin,course,branchs,diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed.Results Originating from radial artery,intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator,the main stem was (4.8±1.0)cm in length and (1.2±0.2)mm in diameter.After its periosteal branches were sent off to distribute over middle and inferior shaft of radius,its cutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm.Perforating point of the cutaneous branch was located (11.1±1.3)cm beneath lateral epicondyle of humerus,its diameter was about (0.6±0.1)mm.Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow,forearm or hand.7 refs.
文摘Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle
文摘To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.
文摘Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.
文摘Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing has traditionally relied on arbitrary timing or subjective measures.This study explores the use of indocyanine green(ICG)angiography in the office setting as an objective guide for timing the delayed pedicled flap pedicle division,aiming to improve surgical outcomes and resource efficiency.In the outpatient setting,ICG is administered intravenously while the flap pedicle is under tourniquet control.If the distal flap opacifies with the tourniquet still applied,appropriate revascularization has occurred,and the pedicle may be safely divided.We present the example of a 47-year-old male with multiple previous flap reconstructions who eventually required a reverse sural artery flap.Initial intraoperative ICG imaging on postoperative day(POD)23 revealed insufficient perfusion,prompting the postponement of pedicle division.Subsequent office-based imaging on POD 47 revealed a persistent lack of neovascularization.Adequate vascularization was demonstrated on POD 81,enabling successful pedicle division in the operating room on POD 121 without complications.ICG fluorescent angiography can guide the timing of division for delayed pedicled flaps.We recommend its use in the outpatient setting to decrease unnecessary operating room usage and anesthetic events and reduce the risk of wound healing complications from early pedicle division.
文摘Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.
文摘Purpose:Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb;a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice.Methods:A retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making.Results:Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1-80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%).Conclusion:The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.
文摘Background: In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised. Case presentation: We report the case of a patient with full thickness burns on both legs, leading to the exposure of joints of the right ankle and the right foot and left patellar tendon. The right lower extremity was covered with a free musculo-cutaneous latissimus dorsi flap. Then, a musculo-cutaneous cross-leg flap pedicled on the anterior branch and centered on a perforator was harvested from the previous redundant flap to cover the controlateral knee. Conclusion: Sequential flap coverage can be considered in cases of extensive soft tissue defects and particularly in burns. This case illustrates that re-using a redundant part of a previous flap to cover another defect is a safe and interesting alternative in the event of a lack of donor sites or to save donor sites for later reconstruction of contracted burn scars.
文摘Reconstruction of head and neck defects is a delicate endeavor that poses numerous intrinsic and extrinsic challenges,which are currently magnified by rising health care costs and limitations in system resources.Current trends in the United States heavily favor the use of free tissue transfer over locoregional pedicles flaps(LRPF);however,the latter group is often undervalued,offering high utility,practicality,and cost-efficiency whilst providing equivalent results.The submental island flap and supraclavicular artery island flap are two LRPF that should be in the arsenal of the modern reconstructive surgeon.
文摘In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robotassisted hepatectomy(RAH) has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the longterm efficacy of both LH and RAH.
基金Supported by AI For Spinal Surgery Planning and Results Assessment Project under the“Priority 2030”Academic Leadership Initiative,No.6.18-01/240724-15.
文摘BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation failure is poor bone quality.On the other hand,some evidence suggests that surgical tactics can influence long-term instrumentation stability.AIM To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.METHODS This study is a non-randomized single center ambispective evaluation of 204 consecutive patients(117 men;87 women)with unstable thoracolumbar injuries.All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation.In cases with spinal cord and nerve root injuries,either posterior or anterior decompression were performed.Patients with pedicle screw loosening were identified via computed tomography imaging.Out of those,cases with clinically significant instrumentation failure were registered.RESULTS The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels,residual kyphotic deformity,laminectomy,and lumbosacral fixation.Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development.Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk,while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure.Anterior decompression does not have a negative impact on instrumentation stability.CONCLUSION Intermediate screws,anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development.Posterior fusion is beneficial in terms of instrumentation failure prevention.
