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PubMed2003

Lower urinary tract reconstruction for duplicated renal units with ureterocele. Is excision of the ureterocele with reconstruction of the bladder base necessary?

PURPOSE: Current practice in reconstruction of the lower urinary tract for duplicated renal systems with an associated ureterocele is excision of the ureterocele with reconstruction of the bladder and a common sheath ureteroneocystostomy. For a nonfunctioning upper pole treatment is partial nephroureterectomy. We postulate that lower urinary tract reconstruction can be performed successfully through an extravesical approach without excision of the ureterocele or reconstruction of the bladder base. We present our experience with that approach. MATERIALS AND METHODS: Between 1996 and 2001, 60 patients presented with the diagnosis of ureterocele and obstruction of the upper pole ureter. Partial nephrectomy was performed in 12 cases of which 4 had reflux to the lower pole moiety. Upper pole only dismembered ureteroneocystostomy was performed in 7 of 15 cases reconstructed using the extravesical approach. RESULTS: Average postoperative stay was 3.7 days. The Foley catheter was removed within 24 to 48 hours. Postoperative ultrasound showed decompression of the obstructed system and the ureterocele. Reflux was corrected in all patients. Flow rate with measurement of post-void residual 6 weeks postoperatively in toilet trained children showed complete bladder emptying. CONCLUSIONS: Lower urinary tract reconstruction for duplicated renal systems with obstruction of the upper pole can be accomplished safely with decreased morbidity through the extravesical approach without excision of the ureterocele or reconstruction of the bladder base. Moreover, in instances when there is no reflux to the lower pole moiety, upper pole only extravesical ureteroneocystostomy can be performed.

Child↗

PubMed2006

Release and free flap reconstruction for trismus that develops after previous intraoral reconstruction.

BACKGROUND: Oral cancer patients receive wide excision of oral structures and reconstruction of the intraoral defects with skin grafts and/or local, regional, or free flaps. Trismus is a common postoperative sequela, even without postoperative radiotherapy. Trismus decreases patients' quality of life and can have detrimental effects on their oral hygiene and nutritional status. METHODS: Between May of 1999 and June of 2003, 11 patients were operated on for release of trismus and reconstruction after previous intraoral reconstructions. The patients had been reconstructed with skin grafts (n = 4), radial forearm flaps (n = 3), anterolateral thigh flaps (n = 1), artificial dermis (n = 1), radial forearm flaps with skin grafts (n = 1), and pedicled pectoralis major flaps with skin grafts (n = 1). Eight patients had received postoperative radiotherapy. The patients presented with a mean interincisal distance of 3.1 mm (range, 0 to 10 mm). RESULTS: After trismus release, the intraoral soft-tissue defects were reconstructed with one or two free flaps (six anterolateral thigh flaps, nine forearm flaps, and one fibula osteoseptocutaneous flap). Fifteen of the 16 flaps were successful, with one flap failure. Average interincisal distance was 33.4 mm immediately after the release (range, 27 to 35 mm) and 18.9 mm (range, 5 to 30 mm) at a mean follow-up time of 22.7 months (16.1 mm in the radiated group and 26.3 mm in the nonradiated group). The mean amount of improvement was 15.8 mm. CONCLUSION: The use of free flaps to reconstruct the defects created after trismus release in patients with previous intraoral reconstruction is a viable option that yields reasonable, long-lasting improvements in mouth opening, intraoral hygiene, and quality of life.

Aged↗

PubMed2004

Focus on the conditions of resection and reconstruction in gastric cancer. What extent of resection and what kind of reconstruction provide the best outcomes for gastric cancer patients?

To assess the roles of the extent of gastric resection and duodenal food passage reconstruction in gastric cancer, we examined a consecutive series of 1,061 patients who underwent total or partial (proximal and distal) gastrectomies with or without duodenal food passage reconstruction between August of 1974 and January of 2002, and received gastrectomies with D2-3 lymph node dissection. Patients who underwent distal or proximal gastrectomy were found to have significantly better survival rates than those who underwent total gastrectomy in stages 1A (10-year survival: 86.6 and 78.9 vs. 61.6%), 2 (56.5 and 65.6 vs. 34.4%), 3A (45.9 and 33.3 vs. 15.2%), and 4 (5-year survival rates: 23.7 and 50.0 vs. 7.1%). Additionally, patients with duodenal food passage reconstruction or double tract reconstruction also showed significantly better survival rates than those without duodenal food reconstruction in stages 1A (10-year survival: 86.4 and 82.5 vs. 61.7%), 1B (69.9 and 90.6 vs. 54.1%), 2 (60.5 and 63.3 vs. 16.5%), and 3A (39.9 and 47.4 vs. 23.1%). In multivariate analysis, the independent prognostic factors were age at operation, depth of tumor, duodenal food passage reconstruction, and lymph node metastasis. Our results indicate that both the extent of gastric resection and duodenal food passage reconstruction were important factors in the outcome of gastric cancer patients, and that surgeons should perform minimal gastric resection with preservation of the duodenal food passage when the gastric stump is tumor-free.

Adenocarcinoma↗

PubMedDate not supplied

Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation.

Arthrofibrosis is a potential complication of acute ACL reconstruction. Arthrofibrosis prevents the patient from regaining full range of motion, particularly the terminal 5 degrees of full extension, postoperatively. We did a retrospective study of 169 acute ACL reconstructions in a population of young athletes (average age, 22 years). We sought to determine the optimal time to perform acute ACL reconstruction with respect to arthrofibrosis and the effects of an accelerated versus conventional rehabilitation program. The short-term results were evaluated by range of motion measurements and 13 week Cybex scores. Patients whose ligaments were reconstructed within the 1st week after injury (Group I) had a statistically significant (P less than 0.05) increased incidence of arthrofibrosis (limited extension, scar tissue) over patients who had ACL reconstruction delayed 21 days or more (Group III). At 13 weeks after the reconstruction procedure, Group III patients scored an average of 70% (compared to 51% for Group I, P less than 0.05) on the Cybex evaluation. They also showed a trend toward more flexion of the knee as well as near full extension. Patients who had an ACL reconstruction between 8 and 21 days after injury (Group II) had a similar incidence of arthrofibrosis as Group I when they followed a conventional rehabilitation program postoperatively. However, only a small number of cases (approximately 4%) of Group II patients who followed an accelerated postoperative rehabilitation program had any arthrofibrosis--an observation we also made in the Group III patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1996

[Reconstructive and non-reconstructive procedures in the treatment of the threatened limb].

Limb threatening ischemia is an acute step in the chronic course of peripheral arterial obstructive disease that requires some form of intervention. The objective of this study is to prove that reconstructive surgery as well as non reconstructive approaches are associated with positive results. Ours is a retrospective analysis of a ten year experience in the treatment of limb threatening ischemia. In the period 1983-93, 139 patients under-went 164 procedures. 67% of patients were diabetics. Early in the observation period the therapeutic strategy was non reconstructive, the procedure of choice was sympathectomy. Later vascular reconstructions have been recognized as the procedures of choice. In the cases not amenable to reconstructive procedures according to our group criteria (absence of a tibial vessel in continuity with a patent pedal arch), we have employed procedures such as prostanoid infusion; thrombolysis and epidural spinal cord stimulation. Reconstructive procedures have been associated with a decrease in the number of major amputations. Alternative procedures, employed in patients not amenable to reconstruction have proven worthwhile in terms of limb salvage even if this trend is limited to a short period of observation.

Arterial Occlusive Diseases↗

PubMed1998

Morbidity and mortality of reconstructive surgery of noninfected false aneurysms detected long after aortic prosthetic reconstruction.

OBJECTIVE: To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis. DESIGN: Retrospective analysis of patient data from a vascular registry that included information on the long-term follow-up of our patients. SETTING: A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958. PATIENTS: We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%). RESULTS: The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%). CONCLUSIONS: Conservative follow-up carries a very high mortality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a false aneurysm can be in the same range as that of elective primary aortic reconstruction. Therefore, we advocate a surveillance program, including yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.

Adult↗

PubMed1994

Advantages of mandibular reconstruction with the titanium hollow screw osseointegrating reconstruction plate (THORP).

Alloplastic reconstruction following segmental mandibulectomy is a simple way to maintain mandibular segmental relationships, partially preserving form and function for many patients. This study is a retrospective review of 40 patients who had mandibular reconstruction with metal plates over a 6-year period (April 1986 through August 1992). The results of reconstruction with titanium hollow-screw osseointegrating reconstruction plates (THORP [n = 12]) and solid screw (SS) steel and titanium plates (n = 28) are compared. One THORP has been removed as compared to 14 SS plates. While the improved results with THORP may be attributable in part to its advanced design, the success of soft-tissue reconstruction and tumor extirpation are important factors in the early outcome seen in this series. Longer follow-up is needed to determine if THORP can serve as a permanent implant. THORP is the authors' method of choice for alloplastic mandibular reconstruction.

Adult↗

PubMed1999

Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction.

Aim of this retrospective study is to evaluate the effect of acute and late anterior cruciate ligament (ACL) reconstruction in patients with a combined injury of the ACL and the medial collateral ligament (MCL). All MCL injuries were treated non-operatively. In 27 patients (group I) we performed early ACL reconstruction (within the first 3 weeks after injury). The postoperative rehabilitation protocol included brace treatment for all patients over a period of 6 weeks. In 37 patients we performed late ACL reconstruction (after a minimum of 10 weeks). In this group initial non-operative MCL treatment (6 weeks brace treatment) was followed by a period of accelerated rehabilitation. Patients with late ACL reconstruction had a lower rate of loss of motion after finishing the postoperative rehabilitation programme and a lower rate of re-arthroscopies for a loss of extension (group I: 4 patients, group II: 1 patient). The difference in the mean quadriceps muscle strength (group I: 83.3%, group II: 86.3%) was not statistically significant. After a mean interval of 22 months, we saw no difference in the frequency of anterior or medial instabilities or in the loss of motion. The Lysholm score was significantly better in the group with late ACL reconstruction (group I: 85.3, group II: 89.9). The position on the Tegner activity scale decreased in both groups, to 5.5 in group I (preoperatively: 6.0) and to 5.6 in group II (preoperatively: 5.9). With regard to the lower rate of motion complications in the early postoperative period, the lower rate of re-arthroscopies, and the significantly better results in the Lysholm score, we prefer late ACL reconstruction in the treatment of combined injuries of the ACL and the MCL.

Adolescent↗

PubMed1992

Critical analysis of mandibular reconstruction using AO reconstruction plates.

Forty-one cases (37 patients) of mandibular reconstruction using AO plates were reviewed. The patients' ages ranged from 27 to 83 years (mean, 52.3 +/- 18.1 years) and their cases were followed for 6 to 42 months (mean, 12.7 +/- 8.3 months). Cases were grouped by the location of reconstruction: anterior mandible crossing midline as group A (12 cases), body segment of the mandible as group B (16 cases), condyle and ramus of the mandible as group C (13 cases). The incidence of revision as a measure of outcome was calculated by actuarial methods accounting for loss to follow-up or death. Revision or plate removal occurred in 22.2% (9 of 41 cases), with an incidence of 52.2% (6 of 12 cases) in group A, 12.5% (2 of 16 cases) in group B, and 7.7% (1 of 13 cases) in group C. Combined use of an AO plate and bone graft had a revision rate of 33.3% (4 of 12 cases), whereas the reconstructions with only a plate had a revision rate of 17.2% (5 of 29 cases). The difference between the immediate reconstructions (19.2%; 5 of 26 cases) and delayed reconstructions (26.7%; 4 of 15 cases) was not significant, but delayed reconstruction of the anterior mandible resulted in the highest failure rate (57.1%; 4 of 7 cases). The revision incidence was significantly higher when the area had been radiated (33.3% of 24 radiated cases and 5.7% of nonradiated cases required revision). In particular, the radiated group A had a remarkably higher failure rate (63.2% of 10 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Use of the 2.0-mm locking reconstruction plate in primary oromandibular reconstruction after composite resection.

OBJECTIVE: To review our experience with 2.0-mm locking reconstruction plate (LRP) system for patients requiring oromandibular reconstruction. STUDY DESIGN: Retrospective case review of 43 consecutive patients who underwent mandibular composite resection with immediate reconstruction. SETTING: Tertiary care center. RESULTS: Forty-three patients underwent oromandibular reconstruction with the 2.0-mm mandibular LRP system and free flaps containing vascularized bone. Mean follow-up was 11 months. There were no intraoperative difficulties utilizing this system. Two (5%) patients had partial fasciocutaneous flap loss resulting in plate exposure. There were no instances of plate fracture or complications requiring plate removal to date. CONCLUSION: 2.0-mm LRP mandibular system is reliable even in the setting of previous or adjuvant radiation therapy. Its technical ease of application, contouring malleability, and very low profile have proven to be advantageous in oromandibular reconstruction. SIGNIFICANCE: No previous descriptions of use of the 2.0-mm LRP in combination with osteocutaneous free flaps for mandibular reconstruction are found in the literature. EBM RATING: C.

Adult↗

PubMed1999

Penile reconstruction, phallic construction, and urethral reconstruction.

Penile reconstruction, phallic construction, and urethral reconstruction require tissue transfer in the majority of cases. This article discusses the techniques of tissue transfer and presents illustrative cases of penile reconstruction, total phallic construction, and urethral reconstruction. The modified forearm flaps for penile reconstruction, the ulnar forearm flap as used for total phallic construction, and the dartos fascial flap and penile skin islands for urethral reconstruction are illustrated. Graft onlay techniques also are shown.

Adult↗

PubMed1996

Analysis of reconstruction of mandibular defects using single stainless steel A-O reconstruction plates.

PURPOSE: This report reviews the results and complications of immediate reconstruction using a single stainless steel A-O plate after resection of mandibles invaded by malignant tumors. PATIENTS AND METHODS: Thirty-four patients were retrospectively evaluated. According to the extent of the tumor, hemimandibulectomy or segmental resection were performed in 4 and 30 cases, respectively. Five of 34 cases required a myocutaneous flap to close soft tissue defects. RESULTS: Nine of the 34 patients died during the follow-up period. Complications occurred in 7 of these patients: plate exposure was caused by local tumor recurrence (4 cases), screw loosening (1 case), and temporomandibular joint pain (2 cases). Twenty-five of the 34 patients (73.5%) were alive, with a mean follow-up of 47.4 months (range 6 to 115 months). Eighteen of the 25 surviving patients with the single A-O plate reconstruction did not show any complications. Thirteen of these (52%) patients had not undergone secondary reconstruction. Five of the 25 patients received secondary reconstruction for cosmetic or masticatory function reasons. Postoperative complications occurred in 7 of the 25 surviving patients (28%): extraoral plate exposure (2 cases), fracture of the plate (1 case), mandibular fracture (1 case), screw loosening (3 cases), and screw fracture (1 case). CONCLUSIONS: On the basis of the findings, it was concluded that a single A-O reconstruction plate can be used for temporary, or sometimes even permanent, reconstruction after mandibular resection.

Bone Plates↗

PubMed1989

A mechanical study of six digital pulley reconstruction techniques: Part II. Strength of individual reconstructions.

A laboratory study was done on fresh-frozen human cadaver limbs, using six types of pulley reconstructions about the flexor tendons of the fingers. The reconstructions used were those described by (1) Bunnell, (2) Karev, (3) Weilby, and (4) Lister, and two types developed by us that have not been previously described. The pulleys were tested at constant strain rate to failure with the peak force recorded as the breaking strength. A total of 385 reconstructed pulleys were tested and the results were analyzed statistically. A new "loop and one half" pulley reconstruction was significantly stronger than the other five reconstructions (p less than 0.01) with an average load to failure of 22.5 kilograms-force. The other pulley reconstructions varied in average breaking strength from 2.8 kilograms-force to 18.4 kilograms-force.

Biomechanical Phenomena↗

PubMed1995

Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease.

PURPOSE: This report evaluates the efficiency of use of the lower extremity deep vein as arterial conduits in the autogenous repair of prosthetic infection after reconstructive aortoiliac surgery. METHODS: We reviewed our records for the period 1990 to 1994 of all patients with prosthetic infection after reconstruction for aortoiliac disease, and we selected for this study all those patients who underwent autograft repair with the lower extremity deep veins. RESULTS: Included were 15 patients: 12 had previously undergone direct aorto(ilio)femoral reconstruction, and three had an extraanatomic prosthetic graft. Thirteen patients were admitted with primary graft infection, and two were admitted with secondary graft-enteric erosion. Treatment consisted of prosthetic excision and aorto(ilio)femoral reconstruction with the superficial femoral vein. In situ reconstruction was performed in 12 cases. The operative mortality rate was 7%. There were no early graft occlusions. One patient underwent an above-knee amputation because of concomitant femoropopliteal occlusion in the presence of a patent deep venous aortofemoral graft. Early postoperative limb swelling was common and was controlled with bed rest, elastic stockings, or intermittent pneumatic compression. The mean follow-up of this series was 17 months (range 4 to 33 months). Two patients died of unrelated causes. One graft occluded after 16 months. There were no reinfections, and all but one patient resumed normal daily activities. Disability from removal of the deep veins was minimal: only one patient continues to wear elastic stockings for limb swelling and shows signs of venous hypertension more than 2 years after surgery. CONCLUSION: Harvesting of the lower extremity deep veins is well tolerated. Autogenous reconstruction with these veins provides good potential for salvage of life and limbs in case of prosthetic infection. A longer period of follow-up is required to study the long-term behavior of these grafts and to allow definite comparison with more conventional approaches.

Aged↗

PubMed2002

Combined chronic posterior cruciate and posterolateral corner ligamentous injuries: a comparison of posterior cruciate ligament reconstruction with and without reconstruction of the posterolateral corner.

Many have advocated the importance of correcting posterolateral rotatory instability (PLRI) in injuries causing rupture of the posterior cruciate ligament (PCL) and posterolateral corner. However, there have been few studies directly comparing the results of reconstructing the PCL in isolation with PCL reconstruction combined with stabilisation of the posterolateral corner. We report on a retrospective study into 17 consecutive patients with chronic combined posterior cruciate and posterolateral corner ligamentous injuries. The mean follow-up was 35 months (range 14-74 months). All patients had unstable knees, with significant PLRI. In 12 cases the PCL alone was reconstructed, in 5 cases a combined PCL and posterolateral corner reconstruction was performed. At a mean follow-up of 35 months, both groups had significantly improved compared to their pre-operative status, as measured by Lysholm and Tegner scores and clinical examination (P<0.01). The group in which only the PCL was reconstructed had significantly lower scores compared to those who had the additional posterolateral corner reconstruction (Tegner P<0.04, Lysholm P<0.02).

Adult↗

PubMed2001

Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.

Introduction: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. Patients and Methods: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. Results: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly +/-1 mm) were not considered as relevant by the patients. Conclusion: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗

PubMed2004

Nipple-areola reconstruction in autologous breast reconstruction: Chinese patients' perspective.

Twenty-five consecutive patients who had nipple-areola reconstruction (NAR) using a modified S dermal-fat flap technique in the Division of Plastic Surgery, Department of Surgery, Kwong Wah Hospital, between 1995 and 2000 were studied. The nipple projection and sensation (to light touch and pinprick) were assessed by a designated surgeon who was not involved in the reconstructive process. This was followed by a questionnaire on the patients' perception of the various physical characteristics of the reconstructed nipple-areola complex (NAC) when in the nude. They were then asked to rate their satisfaction according to a 4-grade grading scale and whether they would recommend this procedure to other women with a similar condition. There was no major complication associated with this procedure. The mean projection of the reconstructed nipple at 18 months was 3.27 mm. The mean projection of the opposite normal nipple was 8 mm. The sensation to light touch and pinprick were 28% and 50% of the normal side, respectively. The majority of the patients were pleased with the reconstruction despite gradual loss of nipple projection and inadequate return of sensation. All patients would recommend this procedure to other women with similar disease. The creation of a NAC on the reconstructed breast mound seemed to enhance patients' satisfaction in this study.

Adult↗

PubMed2005

Secondary reconstruction of failed esophageal reconstruction.

Between June 1992 and November 2002, 17 patients underwent secondary reconstruction of circumferential esophageal defects due to the failure of immediate reconstruction following ablation of thoracic esophageal cancer. Salvage reconstruction was achieved using free jejunal transfer in 13 patients (including long segment with double vascular pedicle in 2 cases), skin and/or musculocutaneous flap in 2 cases, and jejunal pull-up in 2 cases. In 5 patients, the second salvage surgery was required because of the failed first salvage. However, successful restoration of the esophagus and peroral alimentation was finally achieved in 16 of 17 patients, except 1 patient with several salvage operations using skin and musculocutaneous flap because the gut was unusable. We concluded that the preferred first choice for salvage restoration is free jejunal transfer. If the length of the esophageal defect is extensive, colonic interposition or jejunal pedicle with microvascular anastomosis for supercharging is the next option. If these procedures cannot be used, the transfer of a long jejunal segment with double vascular pedicles is recommended. Reconstruction using skin and/or musculocutaneous flap is the final option. As primary wound closure is often difficult in secondary reconstruction of the esophagus, a pectoralis major musculocutaneous flap is reliable to cover the reconstructed esophagus because skin flaps located in the neck region may be damaged by neck dissection or irradiation, and coverage of the anastomosis with muscle between the digestive tracts is effective to prevent leakage.

Aged↗