An innovative surgical approach for solid pseudopapillary neoplasm with duodenal invasion in a pediatric patient: a case report.

BACKGROUND: Pediatric pancreatic tumors, especially with duodenal invasion, are exceptionally rare and a strategy for their treatment has not been established. A pancreaticoduodenectomy is often the desired treatment, but may be over-invasive for solid pseudopapillary neoplasm (SPN). This study reports an innovative surgical approach for SPN with duodenal invasion using pancreatic enucleation and endoscopically guided partial duodenectomy. CASE PRESENTATION: An 11-year-old girl complained of malaise and presented with severe anemia; imaging revealed a tumor of undetermined origin, involving the pancreatic head and descending duodenum. Intraoperative findings showed tumor adherence to the pancreatic head and endoscopy revealed invasion of the duodenum. The tumor was enucleated from the pancreatic head, and partial duodenectomy was performed under endoscopically guided direct visualization. Pathology confirmed SPN with duodenal invasion, and no residual tumor. Although a Grade B pancreatic fistula occurred postoperatively, it was managed conservatively. At the 15-month follow-up, no signs of tumor recurrence, duodenal stenosis, or pancreatic dysfunction were evident. CONCLUSIONS: Given the good prognosis of SPN, we believe that enucleation from the pancreatic head combined with an endoscopically guided partial duodenectomy could be a useful and less invasive alternative to pancreaticoduodenectomy for cases with duodenal invasion.

Practical, cost-effective removal of Hem-o-lok Weck clip: a novel technique.

The Hem-o-lok Weck clip is part of a polymer locking ligation system often employed for hemostasis in surgical practices. Its use is routine in a wide array of surgical subspecialties. Surgeons have limited options in removing these clips when they are aberrantly positioned. Herein, we describe a novel, cost-effective approach for removing a Hem-o-lok clip using standard robotic instruments. This simple approach will allow surgeons to remove a Hem-o-lok clip precisely and quickly if it is not adequately placed. During a routine robotic-assisted laparoscopic prostatectomy a Hem-o-lok Weck clip was noted to be in juxtaposition to the rectal wall, and it was deemed appropriate to remove it. Ultimately, the indwelling Prograsp forceps was moved from the right fourth arm position to the left arm position. This allowed the Prograsp forceps to compress the scissors in the right hand port, which was insufficient in cutting the hinge of the clip. This provided sufficient force to cut through the clip at its hinge with ease. The Hem-o-lok Weck clip is used in various surgical specialties. It is occasionally placed suboptimally and requires removal. Given the challenge of finding and using the clip removal device, surgeons should be aware of this simple and cost-effective way of removing a Hem-o-lok clip if desired.

Anatomical Considerations for Thread Lifting Procedure.

BACKGROUND: Thread lifting is a minimally invasive procedure that enhances facial aesthetics by repositioning sagging tissues with absorbable threads. It requires a comprehensive understanding of facial anatomy for safe and effective results. AIMS: This study aims to highlight the critical anatomical considerations in thread lifting, including the navigation of facial vascular structures, the protection of facial nerves, manipulation of fat compartments, and engagement of retaining ligaments. These factors are essential for minimizing complications and achieving optimal outcomes. PATIENTS/METHODS: A review was conducted focusing on the anatomical elements critical to thread lifting. The study analyzed clinical outcomes related to vascular structures, nerve pathways, fat compartments, and ligaments in patients undergoing the procedure. RESULTS: The review revealed that careful navigation of facial blood vessels is crucial to avoid complications such as bleeding and bruising. Knowledge of facial nerve pathways is essential to prevent nerve damage, which could result in facial weakness or paralysis. Proper manipulation of facial fat compartments helps address aging-related changes, and engaging retaining ligaments is vital for a sustainable lift without tissue distortion. CONCLUSIONS: Thread lifting demands not only technical skill but also a deep understanding of facial anatomy to ensure patient safety and desired aesthetic results. Expertise in these anatomical considerations is essential for minimizing complications and preserving the natural function of facial structures.

Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL): A Single-Center Experience.

BACKGROUND: Urolithiasis is extremely prevalent in Pakistan, with percutaneous nephrolithotomy (PCNL) emerging as the primary treatment modality over traditional open surgery. Despite its effectiveness, PCNL is associated with a risk of complications and residual stones. There is limited data on PCNL outcomes from Southern Punjab, necessitating an evaluation of its efficacy and safety in this region. METHODS: We conducted a retrospective analysis of 399 patients who underwent PCNL at a tertiary care hospital in Muzaffargarh, Pakistan, between October 2016 and September 2022. Detailed preoperative assessments, surgical procedures, and postoperative outcomes were reviewed. Stone clearance and complication rates were assessed, and factors influencing these outcomes were analyzed. RESULTS: The median age of the study population was 39 years, with a male predominance. Stone clearance was achieved in 80.45% (321) of cases, with higher success rates observed in lower pole punctures. Complications occurred in 2% (13) of patients, predominantly hydrothorax following upper pole puncture. Patients with comorbidities had a higher risk of complications (P = 0.097). Residual stones were more common in staghorn stones and larger stone sizes (>3-4 cm). The median operative time was 60 minutes, shorter than reported in the literature, reflecting surgical expertise. CONCLUSION: PCNL is an effective and safe treatment option for urolithiasis in Southern Punjab, Pakistan, with favorable stone clearance rates and low complication rates. Tailoring treatment strategies based on patient characteristics and optimizing surgical techniques are essential for improving outcomes in this population.

Harvesting Costal Cartilage for Secondary Rhinoplasty: Techniques, Considerations, and Outcomes.

Secondary rhinoplasty is a surgical procedure aimed at reshaping the nose after the unsatisfactory results of primary rhinoplasty, which usually requires a reliable source of cartilage for grafting. Septal cartilage is usually the first option for rhinoplasty, but in cases where it is insufficient, rib cartilage might be used, which is the focus of the current study. The article details the surgical techniques for rib cartilage harvesting, highlighting the preference for the seventh rib done under general anaesthesia. The surgery requires a precise incision, harvesting of the cartilage, and careful closure while the cartilage is stored in a saline solution until use. It also introduces innovative approaches to minimize complications and improve patient satisfaction, including trans-umbilical endoscopic harvesting, the use of the 10th rib to reduce morbidity, and employing fresh frozen homologous rib cartilage as a grafting alternative. Based on various studies, most cases following rhinoplasty with rib cartilage showed a high satisfaction rate despite the complexity of the procedure. Patient consideration includes good communication with realistic expectations through imaging techniques. We also discuss complications, which can heavily impact the patient's quality of life. We hope that by providing this information, our paper will provide surgeons and researchers with the latest information on this topic.

Advantages and Disadvantages of Breast Augmentation: Surgical Techniques, Outcomes and Future Directions.

Breast augmentation remains a highly sought-after cosmetic surgery, with various techniques available to enhance breast size using implants or fat transfer. This systematic review, spanning studies from 2003 to 2024 and adhering to PRISMA guidelines, evaluates the outcomes of different surgical approaches concerning scar quality, postoperative pain, patient satisfaction, and complications. The periareolar technique emerges as a favorable option, offering minimal postoperative pain, high patient satisfaction, and precise surgical control with subtle scarring. Transumbilical breast augmentation (TUBA) is noted for its scar-free approach, resulting in low pain and high satisfaction, though it requires specialized training and cannot use prefilled implants. The review highlights the varying complication rates across techniques: modern silicone implants, while safer than earlier injectable materials, still face risks such as rupture and capsular contracture. Autologous fat grafting is generally safer but can lead to issues like erythema and abscesses. The use of effective acellular dermal matrix (ADM) is linked to higher rates of seroma and infection compared to non-ADM procedures, although sterile human ADM shows a lower risk profile. The study underscores the importance of personalized surgical planning to optimize outcomes, as each technique offers distinct benefits and challenges. The findings suggest that future research should aim to refine these techniques and address their associated complications to further enhance patient satisfaction and surgical outcomes in breast augmentation.

Pars Plana Vitrectomy Without Intravenous Anesthesia: Technique, Safety, and Outcomes.

Introduction: To describe the technique, safety profile, and outcomes of performing pars plana vitrectomy (PPV) without intravenous (IV) anesthesia. Methods: This retrospective single-surgeon study comprised patients who had PPV without IV sedation between September 2018 and April 2022. Patients elected to undergo PPV without sedation or with oral sedation via sublingual triazolam administered 30 minutes preoperatively. Sub-Tenon bupivacaine and lidocaine were administered at the initiation of each case. A circulating nurse monitored patient vitals and electrocardiogram tracings without anesthesiologist support. Adverse events (AEs), visual acuity (VA), supplemental block administration, and reoperation rates were documented. Results: A total of 357 PPVs in 319 patients (mean age 68.75 ± 11.17 years [SD]; range, 36.82-98.57) were performed for surgical indications including vitreous floaters, intraocular lens or cataract surgery complications, retinal detachment, vitreous hemorrhage, and epiretinal membrane. Twenty-three cases were performed without sedation, and 334 were performed with oral sedation. For eyes with a follow-up longer than 1 month (n = 324), the preoperative VA of 0.68 ± 0.77 logMAR improved to 0.31 ± 0.46 logMAR postoperatively (P < .01). No intraoperative complications, systemic AEs, need to cease surgery prematurely, or conversion to IV sedation occurred. Five eyes (1.77%) required intraoperative supplemental sub-Tenon block administration, and 95% of patients who had a reoperation (n = 10) or fellow-eye surgery (n = 28) requested the same method of anesthesia without IV sedation. Conclusions: Vitreoretinal surgery with a sub-Tenon block and oral sedation can be safely performed without the support of an anesthesiologist. Additional trials are needed to further quantify patient comfort, surgeon experience, and complication rates.

A Comprehensive Review of Graft Choices and Surgical Techniques in Primary Anterior Cruciate Ligament Reconstruction: An Outcome Analysis.

Anterior cruciate ligament (ACL) injuries are among the most prevalent knee injuries, particularly in athletes engaged in high-impact sports. ACL reconstruction is a widely performed surgical procedure to restore knee stability, prevent further knee damage, and enable patients to return to their previous physical activity levels. However, the success of ACL reconstruction is influenced by various factors, including the choice of graft and the surgical technique employed. This comprehensive review explores the outcomes of different graft options - autografts, allografts, and synthetic grafts - and various surgical techniques such as single-bundle versus double-bundle reconstruction and anatomic versus non-anatomic tunnel placement. The review analyzes the short- and long-term outcomes, including functional recovery, return to sports, complication rates, and the impact of patient-specific factors such as age, activity level, and comorbidities. Additionally, the review discusses the role of rehabilitation protocols in optimizing surgical outcomes. By synthesizing current evidence, this review aims to provide clinicians with insights into the most effective graft choices and surgical techniques for primary ACL reconstruction, ultimately guiding the optimization of patient outcomes and highlighting areas for future research.

The Surgical Management of Pancreatic Pseudocysts: A Narrative Review.

Pancreatic pseudocysts, commonly arising as a complication of acute or chronic pancreatitis, present a significant clinical challenge. This narrative review explores the surgical management of pancreatic pseudocysts, emphasizing advancements, techniques, and outcomes. We examine the indications for surgical intervention, including symptomatic pseudocysts, complications such as infection or hemorrhage, and pseudocysts resistant to conservative treatment. Various surgical approaches are discussed, including open surgery, laparoscopic techniques, and endoscopic interventions. The review highlights the evolution of surgical strategies, from traditional cystogastrostomy to minimally invasive methods, and assesses their efficacy and safety. Additionally, we address patient selection criteria, preoperative assessment, and postoperative care. By synthesizing current evidence and clinical experiences, this review aims to provide a comprehensive overview of the best practices in the surgical management of pancreatic pseudocysts, offering valuable insights for clinicians in optimizing patient outcomes.

Advantages and Disadvantages of Reconstructive and Preservation Rhinoplasty: Surgical Techniques, Outcomes, and Future Directions.

Reconstructive rhinoplasty, a specialized surgical procedure, aims to restore both the form and function of the nose, particularly after trauma, congenital defects, or prior surgeries. This review evaluates the advantages and disadvantages of various surgical techniques used in reconstructive and preservation rhinoplasty. The study focuses on the outcomes of commonly employed methods such as cartilage grafting, flap techniques, and alloplastic materials, assessing both functional and aesthetic results. Recent advancements, including 3D imaging, tissue engineering, and artificial intelligence, are discussed as potential future directions that could enhance surgical precision, safety, and patient care. The review systematically examines clinical studies from the past decade, highlighting the evolving landscape of rhinoplasty and its impact on patient outcomes.

Utilizing a fully digital approach for oral squamous cell carcinoma treatment and zygomatic implant-based rehabilitation for maxillary defects.

This clinical report details the functional and aesthetic rehabilitation of a patient with a severe maxillary defect secondary to subtotal maxillectomy for oral squamous cell carcinoma (OSCCM) using a maxillary prosthesis anchored by four zygomatic implants. The procedure involved meticulous subtotal maxillectomy and defect repair with zygomatic implant support, incorporating advanced digital surgical methods, including 3D reconstruction, computer-guided surgery, and photogrammetry (Icam4D). A 3D finite element analysis (FEA) was conducted to assess the method's efficacy in analyzing stress distribution around the zygomatic implants. The patient expressed high satisfaction with the prosthesis's functionality, aesthetics, speech, and swallowing capabilities, underscoring the value of zygomatic implant-supported maxillofacial prosthetics. This synergy of advanced planning, surgical precision, and biomechanical analysis marks a significant advancement in maxillofacial prosthetics.

Narrative review: evolution in device technology and advances in surgical techniques on AMS 800 device in the last 50 years.

Background and Objective: The current AMS 800 artificial urinary sphincter (AUS) device is designed to simulate the function of the biological urinary sphincter to prevent urinary flow through mucosal coaptation, compression, and pressure transmission. The challenges in designing the AMS 800 device involve not only the mechanical operation of the artificial sphincter device but also producing a device that is effective, safe, and durable for patients in the long term. The following article provides a narrative review regarding the evolution and development of the AMS 800 devices over the years and evaluates the advances in surgical techniques relating to AMS 800 implantation. Methods: Available literature pertaining to the AMS 800 device was reviewed from the MEDLINE and EMBASE databases between 1 January 2000 to 31 December 2022. Emphasis is placed on key scientific publications including previous reviews and clinical guidelines relevant to AMS 800 device(s) and surgical techniques. Key Content and Findings: From the engineering point of view, the current AMS 800 device is ingenious and has stood the test of time. The basic design of this modern AUS consists of 3 separate components namely a pressure regulating balloon (PRB), an inflatable cuff, and a control pump. Continued innovations in device design and technology, coupled with refinements in surgical techniques over the past 5 decades have ensured that the AMS 800 device is and remains the standard of care in male stress urinary incontinence. While the long-term AMS 800 efficacy, safety, and durability are well documented, it is not without its limitations and complications. Mechanical and non-mechanical complications can occur especially in high-risk populations (such as in radiated patients) despite strict adherence to surgical principles and manufacturer's guidelines. Conclusions: Continued innovations in device design, technology, and surgical techniques have ensured that the AMS 800 device is an effective and safe treatment for male stress urinary incontinence (SUI). Future directions in the treatment of male SUI likely reside in cellular regenerative therapy and nanotechnology to restore, replace, or simulate the damaged native urinary sphincter.

A narrative review on synchronous concurrent versus delayed sequential surgery in the artificial urinary sphincter and penile prosthesis implantation.

Background and Objective: In a patient who complains of both stress urinary incontinence (SUI) and erectile dysfunction (ED), prosthetic surgery with a urinary continence device and penile prosthesis implant can offer a definitive solution to address both problems. The AMS 800 artificial urinary sphincter (AUS) device is considered the standard of care to restore SUI while the inflatable penile prosthesis (IPP) device is thought to be superior to a malleable prosthesis to provide a more natural penile erection with higher patient satisfaction rates. The following article explores the current understanding of AMS 800 AUS surgery and IPP device in treating males with concurrent SUI and ED as well as evaluates the advantages and disadvantages of concurrent synchronous dual vs. delayed or staged device implantation. Methods: The available literature on AUS and IPP implantation was reviewed on PubMed and Embase databases between 1 January 2000 and 1 December 2022. This narrative review evaluates relevant key features pertaining to prosthetic surgery with an emphasis on arguments for concurrent synchronous dual vs. delayed sequential surgery for AUS and IPP devices. Additionally, this paper provides a brief surgical description of the techniques and potential complications relating to both prosthetic procedures. Key Content and Findings: While a great deal is known about the excellent outcomes of both AUS and IPP implantation, there is limited literature published on the outcomes of dual AUS and IPP surgery. The decision to proceed with concurrent synchronous dual vs. delayed sequential two-stage implants is likely determined by the patient's preference, the surgeon's expertise, and the availability of prostheses. In either situation, patients should be counselled regarding the advantages and disadvantages of undergoing synchronous concurrent vs. delayed sequential implants and associated surgical challenges are likely dependent on the patient's anatomy and the surgeon's preference. Conclusions: For carefully selected patients with SUI and ED, dual implantation of AUS and IPP provides a definitive treatment to address both conditions at the same time. Patients should be counselled regarding the advantages and disadvantages of synchronous concurrent vs. sequentially delayed implants while technical considerations regarding the sequence of prosthetic device surgery are likely dependent on the patient's factors and the surgeon's preference and surgical expertise.

The male slings: an effective and safe alternative surgical treatment to the artificial urinary sphincter for male stress urinary incontinence?-a narrative review.

Background and Objective: The ideal candidate for a male sling (MS) should have a mild to moderate degree of stress urinary incontinence (SUI). This narrative review article evaluates the current MS devices in the commercial market and examines the role of MS as an effective and safe alternative treatment option for male SUI. Methods: The available literature on MS was reviewed and relevant clinical studies pertaining to each MS were summarised with emphasis on device design and technology as well as specific surgical findings relating to clinical outcomes. Key Content and Findings: Over the past two decades, there have been considerable scientific advances in MS design and technology, and MS is an attractive alternative for patients who might not require or want an artificial urinary sphincter. The modern MS can be classified as adjustable or non-adjustable types and is placed either through a retropubic or transobturator (TO) approach. Strict patient selection and counselling, selection of MS with proven clinical records, and safe surgical practice are paramount to ensure a high continence rate, good patient satisfaction, and low postoperative complications. Published data on various MS materials and devices showed reasonable clinical efficacy and safety outcomes, although many of these synthetic MS devices may not be available worldwide due to a lack of regulatory approval in many countries. While the ideal MS is probably yet to be developed, continued scientific advances in slings design, mesh technology, and more refined surgical techniques will improve the continence rate and deliver better safety records. Conclusions: As clinical data matures with longer-term outcomes coupled with advances in scientific designs and technology, the ability to have and select the optimal MS for a particular patient will come to fruition.

Straightening Crooked Nose with Precise Bone Refining.

Objectives: Crooked noses pose significant challenges in rhinoplasty due to their complex anatomy, particularly in the bony vault. Traditional methods focus on osteotomies but often do not equalize the lengths of the nasal bones. This study introduces a novel technique using otologic drills to address this problem by shortening the longer nasal bone and aligning the nasion-rhinion line at the midline. Methods: A Goodman incision was made to access the nasal bones under general anesthesia. Otologic drills were used for lateral and transverse ostectomies to shorten the longer nasal bone and reposition the nasal bone vault. Follow-ups were conducted 3, 6, and 12 months after surgery. Results: Of 48 cases (22 men and 26 women), 47 achieved satisfactory results with a straightened nose. One case showed a slight deviation after surgery, which did not require revision. Discussion: The technique effectively addresses the issue of asymmetric nasal bone lengths, which traditional methods often overlook. Using otologic drills allows precise bone cutting, contributing to long-lasting outcomes. Conclusions: Otologic drill-assisted ostectomies effectively equalize nasal bone lengths, improving nasal symmetry. More research with larger case series and long-term follow-up is needed to confirm the efficacy and safety of this technique, including potential applications in closed rhinoplasty.

Rhinoplasty for Patients with Cleft Lip-Palate: Functional and Aesthetic Concerns.

Cleft lip and palate, the most common congenital orofacial anomalies, result in complex nasal deformities due to deficient bony maxilla, dentoalveolar arch, teeth, and soft tissues. This article explores nasal deformities in patients with cleft lip and palate, surgical techniques and considerations in cleft rhinoplasty, particularly focusing on nasal valves in both unilateral and bilateral cases. Unilateral cleft lip deformities include asymmetry of the nasal tip, flattened nostril, and displaced caudal septum, while bilateral cleft lip deformities present a wider and flatter nose with complex nasal features.

Evolving indications and surgical techniques for corneal transplantation at a tertiary eye care center in southern China.

BACKGROUND: This retrospective study aimed to analyze the evolution of primary indications and surgical techniques for corneal transplantation in Southern China from 2012 to 2021. METHODS: The medical charts of all patients who underwent keratoplasty between January 2012 and December 2021 at Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Southern China were reviewed. We collected and analyzed the primary indications for corneal transplantation and the surgical methods used in each keratoplasty. RESULTS: The total number of corneal transplantations was 7,286 during this decade, increasing from 210 cases in 2012 to 1054 cases in 2021. The primary indications for keratoplasty included acquired nontraumatic corneal diseases (56.2%), congenital corneal abnormalities (16.4%), acquired traumatic corneal diseases (14.0%), and regraft (13.4%). Infectious keratitis was the leading indication among all keratoplasties (18.5%), followed by regraft (13.4%). Over the decade, the proportion of infectious keratitis gradually decreased (P = 0.013), while the proportion of regraft increased (P = 0.019). The predominant surgical technique was penetrating keratoplasty (PKP), accounting for 56.7%. However, the number of deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK) significantly increased from 2012 to 2021 (P = 0.007 and P = 0.002). CONCLUSIONS: The annual number of corneal transplants significantly increased from 2012 to 2021. In the past decade, infectious keratitis and regraft have become the leading primary indications for corneal transplantation. Although the use of customized lamellar techniques has dramatically increased, PKP remains the predominant surgical technique for keratoplasty.

Comparative Evaluation of Surgical Techniques for Pterygium Management: An In Vitro Study.

Background: Pterygium is a common ocular surface disorder characterized by the growth of fibrovascular tissue onto the cornea, leading to discomfort and visual impairment. Various surgical techniques, including conjunctival autografting, amniotic membrane transplantation, and bare sclera excision, are employed in the management of pterygium. Materials and Methods: Cultured human conjunctival epithelial cells were subjected to simulated pterygium conditions, mimicking the fibrovascular proliferation observed in vivo. Subsequently, different surgical techniques, including conjunctival autografting, amniotic membrane transplantation, and bare sclera excision, were simulated in vitro. Cell viability, proliferation, migration, and inflammatory cytokine expression were assessed using various assays, including MTT assay, scratch assay, and enzyme-linked immunosorbent assay (ELISA). Untreated cells served as controls for comparison. Results: Conjunctival autografting demonstrated superior outcomes in terms of cell viability and proliferation compared to amniotic membrane transplantation and bare sclera excision. Autografted cells exhibited a significantly higher percentage of viable cells and enhanced proliferative capacity compared to cells subjected to other surgical techniques (P < 0.05). Additionally, conjunctival autografting promoted faster cell migration into the defect area, resulting in more rapid wound closure compared to other techniques. Furthermore, reduced expression of inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), was observed in cells treated with conjunctival autografts compared to other groups. Conclusion: In vitro findings suggest that conjunctival autografting may offer superior outcomes in the management of pterygium compared to amniotic membrane transplantation and bare sclera excision.

Different Surgical Approaches to the Treatment of Cleft Palate Fistulae as Perceived by Cleft Surgeons.

OBJECTIVE: Palatal fistulas after palatoplasty could pose difficulties for both patients and surgeons. Numerous surgical approaches are available to treat palatal fistulas. In this manuscript, we investigate surgical treatment options for palatal fistula repair looking at the different anatomical locations, and we create a summary of surgical approaches to facilitate the decision-making process for palatal fistulae repair. DESIGN: In this cross-sectional survey, nine anonymized patient cases with palatal fistulae that differed in severity and anatomical location were presented to participants from the International Cleft Master Course in Amsterdam about "Palatal Fistulas". Participants were invited to participate in this survey. A total of 141 participants reported their preferred surgical treatment options for fistula repair at different anatomical locations. RESULTS: We created different options for fistula treatment, catalogued by fistula location. This overview gives the surgeon possible approaches for each location. If the soft palate is involved, this overview underscores the importance of including velopharyngeal insufficiency management into the fistula repair. For hard palate involvement, our overview lists techniques available for nasal lining repair and for oral lining repair in each region. CONCLUSIONS: We provide a comprehensive overview of potential surgical approaches to repair palatal fistulae. This inventory of techniques is grouped per location to support surgeons in their decision-making process when confronted with a palatal fistula.

Complications and Revision Surgery in Orthopedics Focusing on Traumatology.

BACKGROUND: Orthopedic traumatology, a vital component of orthopedic surgery, poses significant challenges in managing complications and necessitating revision surgeries. These challenges impact clinical outcomes, healthcare economics, and patient well-being. OBJECTIVE: This study aimed to provide insights that informed clinical decision-making and improved patient outcomes by thoroughly examining the range of complications encountered in orthopedic traumatology. Specifically, the research focused on the indications, techniques, and outcomes of revision surgeries. METHODOLOGY: This retrospective cohort research looked at orthopedic traumatology complications and revision procedures over a thorough two-year period from March 2021 to March 2023 at Hayatabad Medical Complex in Peshawar, Pakistan. The following information was gathered from 316 patients receiving orthopedic surgery for traumatic injuries: demographics, kinds of trauma, surgical methods, complications, indications, methods, and results of revision surgery. For data analysis, chi-square tests and descriptive statistics were used, with the goal of finding patterns and correlations within the research population. RESULTS: The average age of the 316 patients was 42.5 years, and 64.76% of them were male (n = 192). The most frequent kind of trauma (n = 218; 69.01%) was fractures, which were mostly brought on by falls (n = 147; 46.52%). The most common surgical method (n = 138; 43.67%) was found to be internal fixation, which was followed by external fixation (n = 67; 21.20%). The most common complication (n = 78; 24.68%) was surgical site infection, which resulted in revision procedures mostly for infection (n = 68; 21.52%) and implant failure (n = 56; 17.72%). Debridement was the most often used revision approach (n = 95; 30.10%), and it was substantially correlated with surgical outcomes, such as increased function (31%) and full resolution (36%). CONCLUSION: This research emphasizes the need to maximize patient outcomes for improved well-being and highlights the crucial role that careful care plays in managing complications and revision operations in orthopedic traumatology.