bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Efficacy of Intraoperative Freehand Erector Spinae Plane Block in Lumbar Spondylolisthesis
Authors: Yeşiltaş Serdar , Abdallah Anas , Uysal Ömer , Yilmaz Sinan , Çinar İrfan , Karaaslan Kazim 
Published: January 2021

Study Design.
Prospective randomized comparative (controlled) study.

Objective.
Management of the severe postoperative back pain followed the major spinal surgeries remains a challenge. The search is going on to find simple, efficient, and reliable perioperative analgesia with low side effects. We aimed to investigate the efficacy of intraoperative freehand erector spinae plane block (ESBP) after spinal surgeries.

Summary of Background Data.
A few case reports and randomized controlled studies demonstrated the analgesic efficacy of ESPB in spinal surgeries. Up-to-date, no randomized controlled studies investigated the effectiveness of ESPB on spinal instrumentation surgeries.

Methods.
We randomly divided 56 consecutive adult patients who underwent posterior spinal instrumentation and fusion for spondylolisthesis into two groups. The study (ESPB) group (n = 28) received intraoperative freehand bilateral ESPB with a 20-mL mixture solution of 0.25% bupivacaine and 1.0% lidocaine equally divided into all operating levels. In the control group (n = 28), 20 mL physiological saline was injected. Postoperatively, we ordered 1 g paracetamol thrice/day, besides patient-controlled analgesia pumps with morphine. We performed a postoperative evaluation with a visual analog scale (VAS), morphine consumption, ESPB-related adverse effects, and postoperative length of hospital stay (PLOS).

Results.
Morphine consumption was significantly higher in the controls within the first postoperative 24-hour 44.75 ± 12.3 mg versus 33.75 ± 6.81 mg in the ESPB participants (P < 0.001). Except for postoperative 24th-hour VAS (P = 0.127), all postoperative VAS scores recorded at all time-points were significantly higher in the controls (P < 0.05). In control individuals, the first analgesic demand time was shorter, and PLOS was longer (P < 0.001). Patient satisfaction was significantly higher in the ESPB group. We observed no significant difference regarding postoperative complications.

Conclusion.
Intraoperative ESPB as a part of multimodal analgesia was effective. For posterior instrumented patients with spondylolisthesis, it can relieve postoperative backache and reduce opioid consumption.

Level of Evidence: 1
Diagnosis and Management of Colonic Volvulus
Authors: Lai Samuel H. , Vogel Jon D. 
Published: January 2021

Case Summary:
An 88-year-old man with no significant medical history, and in a good state of health, presented to the emergency department with 4 days of obstipation, progressive abdominal pain, and bloating. Examination revealed abdominal distension and generalized tenderness without signs of peritonitis. Laboratory values, including lactate and complete blood count, were within normal limits. Computed tomography imaging of the abdomen and pelvis revealed radiological signs of sigmoid volvulus and no evidence of bowel perforation (Fig. 1). Flexible sigmoidoscopic examination revealed no evidence of mucosal ischemia and enabled detorsion of the colon. The patient’s symptoms resolved after the detorsion. He was seen in consultation by a surgeon who advised surgical treatment only if the volvulus recurred. After hospital discharge, the patient self-educated about sigmoid volvulus and sought a second surgical opinion. Five weeks after his initial presentation and 1 week after complete colonoscopy, he underwent laparoscopic sigmoidectomy with colorectal anastomosis. His postoperative course was uneventful. At 6-month follow-up, he remained well with no bowel-related concerns.
A Modified Technique of Laparoscopic Lateral Lymph Node Dissection Combining Fascia-Oriented Dissection and Routine Upfront Distal Visceral Vessels Ligation for Mid- to Low-Lying Rectal Cancer
Authors: Zhang Xubing , Deng Xiangbing , Wei Mingtian , Zhang Hao , Yang Yuanquan , Wu Qingbin , Gu Chaoyang , Meng Wenjian , Wang Ziqiang 
Published: January 2021

INTRODUCTION:
Lateral pelvic recurrence can be a cause of local failure after surgery for low rectal cancer. Lateral lymph node dissection is often performed in East Asia for patients with enlarged lateral lymph nodes or because of the presence of risk factors. However, the outcomes of the conventional lateral lymph node dissection are unsatisfactory, with a considerably high local recurrence rate for patients with positive lateral nodes. Here, we introduce a modified technique to improve lateral nodes clearance.

TECHNIQUE:
This modified technique has 4 key steps: 1) separation of the ureterohypogastric nerve fascia medially, 2) identification of the visceral pelvic fascia and dissection along the inferior vesical or vaginal veins down to the pelvic floor, 3) division of the distal ends of visceral vessels according to the orientation of ureterohypogastric nerve fascia and visceral pelvic fascia for better nerve preservation, and 4) en bloc dissection through a lateral approach over the surfaces of the sacral plexus and piriformis muscle to reveal the course of distal internal iliac vessels before the division of visceral veins.

RESULTS:
Twenty-nine patients underwent laparoscopic lateral lymph node dissection successively with no conversion. The median blood loss for each lateral procedure was 37.5 mL (range, 0–300.0 mL). Eleven lateral nodes (median; range, 1–22 lateral nodes) were harvested for each lateral side. There was no perioperative mortality, and 4 patients developed major complications (Clavien–Dindo III–IV).

CONCLUSION:
This modified technique characterized by the routine division of visceral vessels based on ureterohypogastric nerve fascia and visceral pelvic fascia is feasible and safe. It provides good lymph node harvest, autonomic nerve preservation, and improved bleeding control. Additional investigation is warranted to evaluate the safety, functional outcomes, and oncologic outcomes.
Genitourinary syndrome of menopause: the unmet need
Authors: Spadt Susan Kellogg , Larkin Lisa C. 
Published: January 2021

Abstract
Genitourinary syndrome of menopause (GSM) is a highly prevalent and progressive condition of postmenopausal women that has significant negative effects on vulvovaginal health, sexual health, and overall quality of life. Despite many available safe and effective therapies, GSM often goes undiagnosed and untreated. This Practice Pearl addresses the pathophysiology of GSM and reviews available treatment options.
The Value of Dynamic Infrared Thermography in Pedicled Thoracodorsal Artery Perforator Flap Surgery
Authors: Sjøberg Thomas , Mercer James B. , Weum Sven , de Weerd Louis 
Published: January 2021

Background:
Dynamic infrared thermography (DIRT) is a noninvasive imaging technique that can provide indirect and real-time information on skin perfusion by measuring skin temperature. Although used in flap surgery, there are no reports on its value in procedures using a pedicled thoracodorsal artery perforator (TDAP) flap. The aim of this study was to assess the usefulness of DIRT in preoperative perforator mapping and in monitoring intra- and postoperative flap perfusion of pedicled TDAP flaps.

Methods:
This prospective study comprised 21 patients (21 flaps) scheduled for reconstructive surgery with a TDAP flap. Perforator mapping was done by DIRT, handheld unidirectional Doppler ultrasound, and computer tomography angiography. Intra- and postoperative flap perfusion was assessed by clinical signs and with the use of DIRT and handheld unidirectional Doppler ultrasound.

Results:
Perforator mapping with DIRT showed that first-appearing bright hotspots were always associated with arterial Doppler sounds and suitable perforators intraoperatively. Computer tomography angiography presented useful information on the thoracodorsal artery branching pattern but was less beneficial for perforator mapping. Intra- and postoperative flap monitoring with DIRT was more useful than handheld unidirectional Doppler ultrasound and clinical signs to detect early arterial and venous perfusion problems. DIRT demonstrated that TDAP flap perfusion is a dynamic process with an increase in perfusion during the first operative days. Nineteen flaps survived, of which 3 sustained distal necrosis. Two flaps were lost due to inadequate blood perfusion.

Conclusion:
DIRT provides valuable real-time information for perforator mapping and for monitoring TDAP flap perfusion intra- and postoperatively.
Aesthetic Training in Plastic Surgery Residency
Authors: O’Neill Rebecca , Raj Sarth , Davis Matthew J. , Abu-Ghname Amjed , Reece Edward M. , Winocour Julian , Buchanan Edward P. , Winocour Sebastian 
Published: January 2021

Summary:
Training in aesthetic surgery is a core element in a plastic surgery residency program. Nevertheless, in the past, many studies have shown the lack of resident confidence in aesthetic procedures upon graduation. In recent years, a number of efforts have been made to address this concern, including increasing the required residency aesthetic case requirements and the integration of resident aesthetic clinics to increase exposure and independence in this aspect of training. Numerous studies have been conducted to evaluate the efficacy of these resident-run clinics and have substantiated their value as an important educational tool in residency training and validated their safety in patient care. In fact, survey studies have shown that though residents today show a markedly increased confidence in their training when compared with the past, they still feel there is room for improvement in areas such as facial and minimally invasive surgeries, along with procedures that require higher patient volume to refine. In this article, we review the current state of aesthetic surgery training during plastic surgery residency and discuss future directions in the field.
Comparing Independent and Integrated Plastic Surgery Residency Models: A Review of the Literature
Authors: Bhadkamkar Mohin A. , Luu Bryan C. , Davis Matthew J. , Reece Edward M. , Chu Carrie K. , Buchanan Edward P. , Winocour Sebastian 
Published: January 2021

Summary:
There are currently 2 approved residency training models in the United States conferring eligibility for the American Board of Plastic Surgery examination—the integrated pathway and the independent pathway. While both pathways allow for board certification, there has been much debate regarding the effectiveness of one training model over the other. In this article, we review the existing literature to compare these pathways with regard to quality of trainees, proficiency of graduates, and practice or career outcomes. Ongoing studies are strongly encouraged to continue to identify areas of improvement for both types of training programs.
Lymphovenous Bypass Using Indocyanine Green Mapping for Successful Treatment of Penile and Scrotal Lymphedema
Authors: Frojo Gianfranco , Castro Oscar , Tadisina Kashyap Komarraju , Xu Kyle Y. 
Published: January 2021

Summary:
Male genital lymphedema is a debilitating condition with significant physiologic and psychologic ramifications. Classical surgical treatments for male genital lymphedema include primarily ablative procedures through removal of excess soft tissue, which often have poor aesthetic and functional outcomes. Super microsurgical techniques (including lymphovenous bypass and lymph node transfers) are promising contemporary interventions. In this case report, we aim to share our experience of lymphovenous bypass with indocyanine green (ICG) lymphangiography in the management of penile and scrotal lymphedema. We performed ICG lymphography of the male genitalia and right thigh by injecting ICG at multiple sites followed by concomitant evaluation with a handheld fluorescent portable imager. Skin incisions were designed over the linear lymphatics upstream from the site of obstruction and dermal backflow. Four end-to-end and one end-to-side lymphovenous bypasses were performed. After completion, lymphovenous bypasses patency was confirmed by injecting ICG proximal to the incision and observing flow. At 10-month clinic follow-up, the patient showed marked improvement with improved skin tenting, softer tissues, improved sensation, visible dorsal penile vein, ability to retract foreskin for cleaning, and confidence to engage in sexual activities. This case report describes successful use of lymphovenous bypass in the treatment of penile and scrotal lymphedema using ICG lymphography intraoperatively to map functioning of superficial lymphatics. The full potential of this microsurgical approach is yet to be discovered, and future studies are needed to enhance the long-term outcomes for the treatment of penoscrotal lymphedema.
Simplified Repair of Traumatic Iliac Crest Flank Hernias with Mesh Strips
Authors: Kearney Aaron M. , Dumanian Gregory A. 
Published: January 2021

Background:
Traumatic abdominal wall hernias are rare injuries resulting from blunt abdominal trauma. Traditional approaches have included both open and laparoscopic approaches, with placement of large meshes with giant overlaps. Perhaps the most technically difficult aspect of these repairs is fixating the abdominal wall to the iliac crest. The senior author has developed a method of repair using 2-cm strips of mesh. In this article, we present a description of 4 patients treated with this technique.

Methods:
We included 4 adult patients who underwent traumatic flank hernia repairs by the senior author. We excluded incisional hernias and patients who received a planar sheet of mesh. Demographics and outcomes collected included length of stay, follow-up time, and complications.

Results:
The average age was 38.5 years. Three hernias were due to motor vehicle collision injuries, and 1 was a crush injury at work. No planar meshes or bone anchors were used. No patients required component separation. There were no instances of surgical site infection, hematoma, or wound breakdown. All repairs were intact at the time of last follow-up (average, 24.3 months; range, 4–48.7 months).

Conclusions:
Traumatic flank hernias are rare injuries that can be difficult to address. Here, we describe a technique of primary repair with mesh strips that distribute the forces of repair across a greater surface area than can be achieved with sutures. Placing drill holes through the iliac crest avoids the cost and complexity of suture anchors.
Surgical Correction of Inverted Nipples
Authors: Mangialardi Maria Lucia , Baldelli Ilaria , Salgarello Marzia , Raposio Edoardo 
Published: January 2021

Background:
Nipple inversion is a common pathologic condition affecting 2%–10% of women. Congenital inversions are the most common forms, while acquired inversions are less frequent. This condition can induce psychological discomfort, functional problems that could prevent adequate breast feeding, and cosmetic dissatisfaction, and create local irritation and infection. The aim of this article was to provide a comprehensive review of the literature about surgical treatment of inverted nipple.

Methods:
A literature search was conducted by using PubMed, Google Scholar, and Cochrane database using the following MeSH terms: “inverted nipple,” “inverted nipple surgery,” “inverted nipple treatment,” and “inverted nipple management.” Studies that described surgical treatment and included outcomes and recurrence rate were included.

Results:
Thirty-three articles were considered suitable, including 3369 inverted nipple cases. Eight studies described techniques with lactiferous ducts damaging, while 25 studies described techniques with lactiferous duct preservation using dermal flaps, sutures, or distractor systems. The average follow-up was 23.9 months. Overall, a satisfactory correction was reached in 88.6% of cases, and the recurrence rate was 3.89%.

Conclusions:
To our knowledge, our review includes the largest sample size in the literature. The heterogeneity and subjectivity of outcomes make it more complicated to state which is the best surgical strategy to adopt to obtain satisfactory and stable results with minimal morbidity. This study highlights the need of a standardized method to evaluate outcomes, including aesthetic, functional and psychological results, while using objective and subjective measurement instruments.
Breast Reconstruction in a Coronavirus Disease 2019 Hub
Authors: Lisa Andrea , Battistini Andrea , Giannasi Silvia , Veronesi Alessandra , Bandi Valeria , Maione Luca , Vinci Valeriano , Tinterri Corrado , Babbini Marco , Klinger Marco 
Published: January 2021

Background:
The coronavirus disease 2019 (COVID-19) pandemic presented a dramatic challenge to healthcare systems. Humanitas Clinical and Research Hospital (Rozzano, MI, Italy) was declared a regional hub for the treatment of COVID-19 patients. Our plastic surgery team, in consultation with our breast surgery colleagues, decided to perform immediate implant-based breast reconstruction for patients undergoing mastectomy for cancer. In this report, we present our experience performing breast reconstruction with a new protocol in the first month following the COVID-19 pandemic in the most affected region in Italy.

Methods:
We adopted a new protocol to treat patients with breast cancer during the COVID-19 pandemic. The main goals of our protocol were to reduce the risk of COVID-19 spread for both patients and clinicians, postpone nononcologic and more advanced surgery, develop rapid recovery for early patient discharge (within 24 hours from surgery) through pain management, and finally reduce postoperative consultations.

Results:
The protocol was applied to 51 patients between early March and early April 2020. After 1 month, we decided to retrospectively review our experience. We found no significant differences in terms of postoperative pain and complication rate compared with our data in the pre-COVID period.

Conclusion:
Our new protocol is safe and effective, enabling tumor resection and immediate implant-based breast reconstruction, without increasing risks to the patient or staff.
How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
Authors: Shekher Rohil , Lin Lawrence , Zhang Rosaline , Hoppe Ian C. , Taylor Jesse A. , Bartlett Scott P. , Swanson Jordan W. 
Published: January 2021

Background:Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear.Methods:A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway.Results:Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy (P< 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48,P< 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire,P< 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division.Conclusions:Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.
Endoscopic Lipoabdominoplasty
Authors: di Diego Juan M. 
Published: January 2021

Summary:
Endoscopic lipoabdominoplasty is the surgical technique utilizing endoscopy, as in a conventional abdominoplasty, to repair acquired abdominal wall defects, such as diastasis recti or ventral hernias. A conventional liposuction is carried out through 4 ports, which shall be used later to place the laparoscopic trocars for fat removal and supra-aponeurotic undermining. Three trocars are introduced through these ports, one for the camera and the others to introduce surgical instruments. A CO2 insufflation is carried out; the supra-aponeurotic space is undermined up to the xiphoid process. Then a rectus muscle plication is carried out with slow-absorbing sutures in 2 or 3 sections. Two Jackson Pratt drains are placed, and the incisions are closed. The objective of this article is to describe the technique and establish the necessary safety criteria to obtain good results in patients with minimal skin laxity, with moderate fat tissue distribution, with musculofascial diastasis, with ventral hernias, and who do not need or do not accept a visible surgical scar.
Regenerative Wound Healing by Open Grafting of Autologous Fat and PRP-Gel – A New Concept and Potential Alternative to Flaps
Authors: Rangaswamy Mohan 
Published: January 2021

Summary:
A new regenerative technique is described that enabled in situ formation of soft tissue bridge for difficult wounds, which otherwise needed flaps, resulting in complete healing in 3/3 cases. The wounds were debrided till healthy bleeding and covered with a triple-layer matrix of platelet-rich fibrin gel, condensed liposuctioned autologous fat, and porous collagen dressing. Negative pressure wound therapy was applied after 48 hours for 4–5 days in 2 cases and after 11 days for 3 weeks in the third case. Rapid vascularization was noted, with regeneration of mature tissue bridge and subsequent epithelization even over the bone. One patient underwent elective replacement of healed epithelium by split skin graft for better aesthetics and durability. This technique, if further validated, may herald a new concept of in situ regeneration, namely transformation of autologous tissue (grafted in gel form) to viable soft tissue.