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Case 3.12
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
What not perform a capsulotomy?I would not advise this procedure as a routine, as it has an up to 90% rate of capsular recurrence and may result in visible ridges.However, if the patient does not want a change of implant, or the morbidity of a capsulectomy, then a capsulotomy is an option if she accepts the risks of that.
The Spastic Knee – Knee Flexion in Spastic Cerebral Palsy
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
The knee flexion contracture can be addressed by serial stretch casting when mild. We utilise stretch casting for moderate to severe deformities with the goal of correcting the deformity to around −15 to –20° before osteotomy. We have no experience with posterior capsulotomy, but would anticipate that the risks of both nerve stretch injury and relapse would be higher than with osteotomy. Sciatic nerve injury is a risk with acute correction by capsulotomy or osteotomy.3 Most authors perform a distal femoral extension osteotomy often with shortening,3,5–9 and others have reported adequate correction with a shortening osteotomy alone.10 An increase in anterior pelvic tilt (4–10o) is a common finding after osteotomy7,8,10 even when an intramuscular lengthening of the iliopsoas was performed concomitantly.8
Surgery of the Ankle
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Matthew Welck, Laurence James, Dishan Singh
The extensor retinaculum is divided in the line of the incision. We tend to create medial and lateral flaps of the retinaculum as we are opening it, in order to facilitate closure and prevent bow stringing of the tibialis anterior tendon. Large skin flaps are avoided to reduce the risk of necrosis. The approach is then developed either between the extensor hallucis longs (EHL) and the extensor digitorum longus (EDL) or (more commonly) between the tibialis anterior and the EHL. The key is protecting the dorsalis pedis artery and deep peroneal nerve – identification (and protection) of these structures more proximally, before they cross at the ankle joint itself, may be required. A longitudinal capsulotomy is then performed.
Early onset of capsular contracture after breast augmentation with implant: report of two cases & review of literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Subhi M. K. Zino Alarki, Hatan Mortada, Asma I. Abdullah, Hisham Alkhalidi, Musab Alrehaili
A 43-year-old female patient with a history of right breast cancer underwent right mastectomy and breast reconstruction with a Becker implant for eight years. No history of radiotherapy. She had implant exchange surgeries twice at different intervals previously. The last was on the 11 October 2020, as she was not satisfied with the right breast size with no other indications such as trauma or implant rupture. Therefore, the implant was exchanged with a 550-cc smooth Motiva® silicone implant and discharged afterward without any complications. A capsulotomy was done. Afterward, she presented to our clinic after nine weeks complaining of pain and redness over the right breast with a heaviness extending to the back and shoulder. On examination, the surgical site looked clean and healed—no noticeable discharge, signs suggesting undergoing infection or implant rupture (Figure 1).
The outcome of minimally invasive surgery for digital mucous cyst: a 2-year follow-up of percutaneous capsulotomy
Published in Journal of Dermatological Treatment, 2022
Wei Hsiung, Hui-Kuang Huang, Tung-Ming Chen, Ming-Chau Chang, Jung-Pan Wang
This was a prospective study designed to evaluate the efficacy of this percutaneous capsulotomy method. All participants provided written informed consent before participation. The protocol of this research was approved by the ethics committee of our institution. Forty patients with 42 DMCs were included. Patient data on demographic variables and DMC characteristics, including location and size of the cysts, symptoms, duration of cyst appearance, and nail deformity, were recorded. Plain radiography was evaluated for grading of the severity of osteoarthritis of the relevant joints (14). We excluded patients with systemic arthritis (e.g. rheumatoid arthritis), and patients with previous middle/distal phalanx fracture and nail bed injury of the involved digits. All operations were performed by a single hand surgeon (experience level III – an experienced specialist) (15).
Femtosecond Laser Assisted Cataract Surgery: A Review
Published in Seminars in Ophthalmology, 2021
The capsulotomy incision starts below the surface of the anterior capsule and continues through the capsule cutting in a cylindrical or spiral fashion.4,27 The Catalys initiates its capsulotomy incision at a depth of 0.6 mm whereas the Z8 initiates it at 0.8 mm. The VICTUS depth is unknown.2 The capsulotomy can be centered on the pupil center, pupil maximized center, scanned capsule (specific to Catalys), or custom placement. Bafna conducted a study comparing capsulotomy-IOL centration after scanned capsule versus pupil-centered capsulotomy, given the haptics make the IOL center within the bag itself naturally. In 82% of patients, the scanned capsule capsulotomy method offered better centration between the capsulotomy and IOL and 100% had 360 degree capsulotomy-IOL overlap.32 Kránitz et. al. found IOL decentration was six times more likely to occur in patients with a manual capsulorrhexis versus FSL capsulotomy.33 Centration is pivotal when creating capsulotomies for patients receiving multifocal and toric IOLs, as capsulotomy-IOL centration is key to their efficacy.