A Prospective Evaluation of Early Postoperative Complications After Distal Biceps Tendon Repairs.

PURPOSE: The reported incidence of postoperative complications after distal biceps tendon repairs (DBTRs) has been determined largely by retrospective studies. We hypothesized that a large prospective cohort study of DBTRs would demonstrate increased complication rates relative to existing literature values. Secondarily, we hypothesized that most complications would be transient and self-limiting, regardless of the surgical technique employed for the repair. METHODS: Consecutive patients undergoing acute, primary DBTR from July 2016 to December 2017 were enrolled. The repair technique, postoperative protocol, and follow-up intervals were determined by the individual surgeons' protocols. Demographic information, surgical data, and complications were tabulated prospectively. Exclusion criteria included chronic DBTRs, secondary DBTRs requiring allograft, DBTRs of partial tears, and postoperative follow-up of less than 12 weeks. We included 212 repairs performed by 37 orthopedic surgeons in 3 different subspecialties. RESULTS: Sixty-five patients (30.7%) had 73 complications. Fifty patients (44.6%) in the 1-incision group experienced complications compared with 15 (15.0%) in the 2-incision group. Sixty patients (28.3%) developed a minor complication. Fifty-seven patients (26.9%) had sensory neurapraxias, 47 after a 1-incision procedure and 10 after a 2-incision procedure, a statistically significant difference. Of the patients with neurapraxias, 94.7% were resolved or improving at the time of the latest follow-up. Five patients (2.4%) developed a major complication, defined as a return to the operating room in the postoperative period due to deep infection or rerupture. CONCLUSIONS: The complication rate after DBTR appears to be higher than 2 other retrospective studies and is predominantly in the form of transient neurapraxias. This study confirms that there is a higher complication rate in 1-incision techniques as compared with 2-incision techniques. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Oblique retroperitoneal approach for lumbar interbody fusion from L1 to S1 in adult spinal deformity.

In recent years, with advancements in surgical techniques and instrumentation, the lateral lumbar interbody fusion is being used increasingly as an alternative procedure to anterior approach. In this study, we illustrated a oblique retroperitoneal approach for lumbar interbody fusion with one incision site and tilting of the operation table in adult spinal deformity and evaluate the radiographical findings and clinical outcomes of patients treated using this technique. This study included 32 patients scheduled to undergo anterior and posterior long-level fusions for lumbar degenerative kyphosis or degenerative lumbar scoliosis. Data collected included blood loss, operative time, incision size, and perioperative complications. Pre- and postoperative radiographic parameters and clinical outcome measures were assessed. Mean follow-up time was 26.1 months. The mean blood losses were 107.4 and 102.4 ml, and the mean operative times were 116, 97, and 82 min for the patients within five levels (4 cases), four levels (18 cases), and three levels (10 cases). The mean incision sizes were 14.63, 13.82, and 12.5 cm in the patients with five, four, and three levels. The mean pelvic incidence was 50.3°. The mean preoperative sagittal vertical axis (SVA) was + 13.66 cm, and the last follow-up SVA was + 2.94 cm. The preoperative lumbar lordosis (LL) was 5.79°, and the last follow-up LL was 46.54°. The mean correction angle was 41°. The mean Cobb angle decreased from a preoperative value of 21.55° to 9.6°at the last follow-up. An oblique retroperitoneal approach is very safe, allowing reproducible access from L1 to S1 for lumbar interbody fusion in adult spinal deformity.

Delayed repair of distal biceps tendon ruptures is successful: a case-control study.

BACKGROUND: The literature has shown an increased complication rate with a delay to surgical repair of acute distal biceps tendon ruptures; however, little has been documented regarding the outcome of delayed repairs. This case-control study compared a study cohort of delayed (>21 days) distal biceps tendon repairs with a control cohort repaired acutely (<21 days). METHODS: Sixteen delayed repair cases were reviewed and matched with acute controls (1:3) based on repair technique, age, and workers' compensation status. The delayed cohort was reviewed and completed isometric strength testing and the Disabilities of the Arm, Shoulder and Hand questionnaire; Patient-Rated Elbow Evaluation; and American Shoulder and Elbow Surgeons elbow questionnaire. RESULTS: The time to surgery averaged 37 ± 12 days in the delayed cohort versus 10 ± 6 days in the acute cohort. Complications occurred in 63% of patients in the delayed cohort versus 29% in the acute cohort (P = .04); however, 90% of the delayed cohort's complications consisted of transient paresthesias. Follow-up scores on the Patient-Rated Elbow Evaluation, Disabilities of the Arm, Shoulder and Hand questionnaire, and American Shoulder and Elbow Surgeons elbow questionnaire were not statistically different between cohorts (P > .37, P > .22, and P > .46, respectively). CONCLUSIONS: Despite a high rate of initial complications, patients treated with distal biceps tendon repair after a delay (>21 days) can expect similar functional outcomes to those treated acutely.

Single incision fasciotomy for acute compartment syndrome of the leg: A systematic review of the literature.

Purpose: To review published literature assessing clinical outcomes and complication rates of single incision fasciotomy in fractures of the lower leg. Methods: We searched PubMed and EMBASE for articles published through July 5, 2021, using the terms "single incision fasciotomy", "acute compartment syndrome of the limbs", "compartment syndrome fasciotomy", and "(compartment syndrome fasciotomy) AND (incision)". The inclusion criteria were studies of Level I to IV evidence in English, published in 1970 or later, involving human subjects, reporting clinical outcomes of single incision fasciotomy performed in cases of acute compartment syndrome in lower leg fractures, including at least 1 patient. Results: Among the 3040 combined total results, 11 primary studies met our inclusion criteria. Adequate and safe compartment release was achieved with single-incision technique. No significant difference was found in terms of complications such as infection and non-union. Conclusions: The comparative efficacy and safety of single-incision fasciotomy is relatively equal to the two-incision techniques when evaluated in the literature. However, double-incision fasciotomy remains the predominant surgical technique, widely preferred by surgeons due to the familiarity with the technique and ease of full compartment release. In addition to the actual fasciotomy procedure, data suggests that operative timing, closure and fixation techniques can significantly impact patient outcomes. These findings may be used to guide the orthopedic community when determining the optimal incision-type to use in acute compartment syndrome emergencies for lower-extremity fracture cases in conjunction with closure and fixation techniques.

One incision-two windows approach for fixation of multifragmentary coronoid process fracture of the ulna: A case report.

Since the range of access of each surgical approach around the elbow has limitations, it is difficult to treat all types of fractures using only one approach. In the case reported herein, anterior and medial fragments of the comminuted ulnar coronoid process fracture were treated by preparing two access routes through one skin incision and effectively performing the buttress plating of each fragment. The subject was a 27-year-old female who sustained a fracture of the coronoid process of the right ulna by falling during snowboarding. Computed tomography showed the concurrence of a type 2 subtype III and type 3 subtype I ulnar coronoid process fracture according to the O'Driscoll classification. The coronoid process was split into 3 parts: a fragment consisting of the anteromedial facet and upper half of the sublime tubercle (fragment 1), a central fragment including the tip (fragment 2), and a fragment extending from the radial side of the tip to the base of the coronoid process (fragment 3). A 12-cm-long skin incision was made on the anteromedial side of the elbow joint. The region of the anteromedial facet and sublime tubercle was reached by passage between the palmaris longus/flexor digitorum superficialis and humeral head of flexor carpi ulnaris using the over-the-top approach. Fragment 1 was fixed with a buttress plate. Using the anterior approach, the brachialis was then longitudinally split through by passage between the biceps and neurovascular bundle, fragments 2 and 3 were fixed together with a buttress plate. The "one incision-two windows" approach, which provides two approaches (the over-the-top window and the anterior window) by a single skin incision, was implemented for a multifragmentary ulnar coronoid process fracture. This approach is considered to offer access from the front to each of the anterior and medial fragments and permits appropriate buttress plate fixation.

Tension-Free Vaginal Tape-SECUR Procedure for the Treatment of Female Stress Urinary Incontinence: 3-Year Follow-Up Results.

OBJECTIVES: To assess the efficacy and complications associated with the use of the tension-free vaginal tape (TVT)-Secur system device for the treatment of female stress urinary incontinence (SUI) based on a 3-year follow-up. METHODS: Women with SUI were randomly allocated to either the U- or H-type groups depending on the TVT-Secur approach used. Patients were questioned about continence and satisfaction 1, 2, and 3 years after surgery. Patients were assessed postoperatively by questionnaires including Sandvik, Incontinence Quality of Life (I-QoL), Bristol Female Lower Urinary Tract Symptoms-Scored Form (BF-LUTS), incontinence visual analogue scale (I-VAS), and benefit, satisfaction, and willingness to continue questionnaire. Cure was regarded as no leakage on the Sandvik questionnaire. RESULTS: A total of 115 patients with SUI were included in this study (U-type: 53, H-type: 62). A total of 102 patients were followed-up for 3 years (U-type: 47, H-type: 55). The overall cure rate at the 1-, 2-, and 3-year follow-ups was 87.8, 83.0, and 79.4%, respectively, and there was no difference in the cure rate between the U-and H-type approaches. Approximately 83.4 and 83.3% of patients were satisfied with the surgical outcome at the 1- and 3-year follow-ups. I-QoL, BFLUTS-SF, and I-VAS were improved from baseline regardless of the approach used at the 1- and 2-year follow-ups. Complications included intraoperative vaginal wall perforation (three cases), voiding difficulties such as immediate postoperative retention, and urgency episodes. CONCLUSIONS: Both U- and H-type approaches of TVT-Secur for the treatment of female SUI remains efficacious, safe, and satisfactory for up to 3 years after surgery.

Distal Biceps Injuries.

A review of distal biceps tendon injuries is presented. Notable and recent studies on the incidence, presentation, diagnosis, and treatment are outlined. The benefits and risks of 1- and 2-incision techniques for repair are discussed, and classic studies are reviewed.

Single incision approach to totally extraperitoneal inguinal hernia repair.

INTRODUCTION: Nowadays the vast majority of inguinal hernia repairs are laparoscopically assisted. Single incision laparoscopy aims to accelerate recovery and provide a better cosmetic outcome after the operation. AIM: To present our own modification of the totally extraperitoneal (TEP) procedure with a single incision and without a multiport, and compare the results with those obtained in the classic three-trocar TEP method. MATERIAL AND METHODS: The study group comprised 61 males. The first group consisted of 35 males who underwent single incision videoscopic alloplasty TEP. The second group comprised 26 males who underwent videoscopic alloplasty using the classic approach. The study assessed the time of operation, complications and postoperative pain based on the VAPS scale. RESULTS: The operation time in the first group was statistically longer compared with the time in the second group. The assessment of differences in postoperative pain in both the examined groups on the first and seventh day after the operation was considered statistically insignificant. In both the studied groups there was no recurrence of hernia established on the first and seventh day after the operation. CONCLUSIONS: The reduced number of incisions in the TEP method with a single incision approach without a multiport involves a decrease in the number of postoperative scars, and thus offers a better cosmetic outcome compared with the classic TEP procedure. The time of TEP operation performed with a single incision approach without a multiport is statistically longer than the duration of the classic laparoscopic TEP procedure.

Apendicectomía laparoscópica urgente con una sola incisión umbilical / Urgent laparoscopic appendicectomy with just a single umbilical incision

La cirugía laparoscópica se enfoca hacia el desarrollo de técnicas cada vez menos invasivas. Con el avance tecnológico es posible introducir a la cavidad abdominal múltiples instrumentos a través de un mismo puerto. Describimos la técnica de la apendicectomía laparoscópica mediante la utilización de tres puertos de acceso a través de la misma incisión umbilical, utilizando instrumental convencional, en un paciente de 33 años de edad, con dolor abdominal de 18 horas de evolución. La intervención se realizó de forma exitosa, sin complicaciones intra ni posoperatorias. El paciente egresó a las 12 horas de operado. La apendicectomía en pacientes adultos mediante una sola incisión es una técnica segura y fácilmente reproducible cuando existe entrenamiento adecuado(AU)

The laparoscopic surgery is focused on the development of increasingly less invasive techniques. The technological advances have made it possible to introduce many medical instruments into the abdominal cavity through the same port. Here is the description of the laparoscopic appendicectomy by using three ports of access through the same umbilical incision to introduce the conventional instruments in a 33 years-old patient who had suffered abdominal pain for 18 hours. The surgery was successful, neither intraoperative nor postoperative complications occurred. The patient was discharged after 12 hours of operation. Appendicectomy in adults by using just a single incision is a safe, easily reproducible technique when appropriate training is present(AU)