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Neuromuscular Scoliosis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
Surgical planning needs to be comprehensive as cases are complex and require multi-disciplinary input. The multisystem pathology of CP patients requires careful optimisation. Particular attention needs to be paid to respiratory function, as performing a spinal fusion in a skeletally immature patient may impair growth of the thorax and lung function. Pre-existing neurological disorders such as epilepsy may be exacerbated by general anaesthetic (GA). Disorders of the gastrointestinal (GI) system such as gastro-oesophageal reflux disease are common in CP patients and place the child at significantly increased risk of aspiration and poor oral intake with resultant malnutrition. The risks of surgery including catastrophic neurological injury and medical/anaesthetic complications would also need to be outlined in detail. Post-operative complications are also higher in this patient population.
Virtual Surgical Planning for Left-Ventricular Myectomy in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Prahlad G. Menon, Srilakshmi M. Adhyapak
In this section, we describe surgical LV myectomy for patients with obstructive HCM in an in vitro setting. Here, rather than utilizing the 3D printed models as a basis for visualizing optimal surgical strategy, physical prototypes may be useful to actually practice the optimal surgical approach dictated by means of an image-based virtual pre-surgical planning step, prior to operating on the real patient. Three-dimensional prints of the LV chamber (factoring in the regional wall thickness) of patients with hypertrophy can be prepared with the goal of virtually resecting obstructions to blood flow out of the LV outflow tract, in the interest of facilitating optimal surgical myectomy through the experience of a pre-surgical performance with a full 3D field of view of the target anatomy (i.e., the LV).
Osteoporotic distal femoral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Richard Stange, Michael J. Raschke
Surgical planning determines the precise needs for material. The surgical team needs to be prepared for complex fixation techniques such as double plating, strut grafting techniques, augmentation of the osteosynthesis, or conversion to revision or tumor prosthesis. Not all centers have permanent access to segmental reconstruction implants (tumoral reconstruction implants), rotating hinged implants, or revision implants with metal augmentation systems. Thus, although these patients are admitted in emergency, surgery has to be accurately planned as fast and as precisely as possible, taking account of the time needed to procure equipment. The surgical team should also be carefully chosen and experienced in trauma and reconstructive surgery as well as in arthroplasty revision surgery.
The evolution of breast reconstructions with free flaps: a historical overview
Published in Acta Chirurgica Belgica, 2023
Filip E. F. Thiessen, Nicolas Vermeersch, Thierry Tondu, Veronique Verhoeven, Lawek Bersenji, Yves Sinove, Guy Hubens, Gunther Steenackers, Wiebren A. A. Tjalma
Women confronted with mastectomy after breast cancer have many options when considering an autologous breast reconstruction. A multidisciplinary surgical approach resulted in in an exponential growth in breast reconstruction possibilities. A reconstructed breast should appear and feel realistic using reconstructive surgery with minimal donor site morbidity and low-risk surgery. Microsurgical breast reconstruction with perforator flaps offers reliable, durable and esthetically pleasing reconstructions, with minimal functional donor site morbidity. The abdominal donor site with the DIEP flap remains the workhorse for the reconstructive microsurgeons, offering a reliable flap with a good donor site morbidity and pleasing esthetical outcome. Careful patient selection, surgical planning and technical execution are essential to success of the surgical treatment. When the abdomen is not available the thigh flaps (TMG/TUG/PAP) are useful as a second choice. The flaps from gluteal region can be used as a lifeboat. The use of CT scan helps the microvascular surgeon to select the perforator with best vascularization. DIRT is a novel technique which has to potential to contribute to minimize complications and improve outcomes in the future.
Cataract Following Pars Plana Vitrectomy: A Review
Published in Seminars in Ophthalmology, 2021
Erick Hernandez-Bogantes, Alexandra Abdala-Figuerola, Andrew Olivo-Payne, Fabian Quiros, Lihteh Wu
Before undergoing any surgery, it is important to do a thorough preoperative examination and balance the risks and benefits. In previously vitrectomized eyes, it is important to determine if the cataract is the cause of visual loss or is it the underlying vitreoretinal disease before making a surgical decision. When a decision to operate has been made, it is important to analyze and identify the potential risks prior to the surgical intervention for adequate surgical planning. Risk factors include a poor pupillary dilation, zonular weakness, silicone oil in the anterior chamber or injury to the posterior capsule,37,65 in addition to the anatomical changes induced by PPV.36,39,66 A Cochrane review revealed that there is no evidence from randomized controlled trials for cataract surgery recommendations in a post-vitrectomy setting.36
A superficial nasal dermoid cyst excised through a novel horizontal zig-zag incision in a 49-year-old man
Published in Acta Oto-Laryngologica Case Reports, 2020
Jeremy Wales, Babak Alinasab, Ola Fridman-Bengtsson
The classical presentation of a dermoid cyst can often give a hint to its diagnosis and is considered to be pathognomonic. However, clinical examination of NDCs alone cannot rule out intracranial extension. The majority of NDCs are classified as simple and do not involve underlying structures. However, more complex NDCs can involve the nasal bones, skull base or include an intracranial component [9]. Therefore, good surgical planning is essential. Moses et al. [2] recommends an initial CT and if the diagnosis is unclear to proceed to MR, however, Herrington et al. [6] recommends MR as the first investigation so as to reduce radiation exposure in children. CT can be used to assess the bony anatomy associated with the NDC. One often sees a wide foramen caecum (>3 mm) and a bifid crista galli. However, these findings do not necessarily indicate intracranial extension [10]. MR should be used to follow the course of the fistula or cyst and conclusively rule out/in intracranial extension [7]. We, as well as others [4], would recommend that the initial investigation in adults should be a CT to define the bony anatomy and then an MR to determine intracranial extension and operative planning. Hartley et al. [11] proposed a radiological classification of NDCs divided in to four groups: superficial, intraosseus, intracranial extradural and intracranial intradural, to allow better surgical planning.