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Late Postoperative Period (late + postoperative_period)
Selected AbstractsAccessory nerve function after level 2b,preserving selective neck dissectionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2009Bilge Celik MD Abstract Background. The aim of this prospective study was to evaluate the relationship between accessory nerve functions and level 2b,preserving selective neck dissection. Methods. Forty-one necks of 30 patients with laryngeal cancer who underwent unilateral or bilateral level 2b,preserving neck dissections, between February 2003 and July 2005, were evaluated. Neck and shoulder movements and muscle strengths were examined and electroneuromyography (ENMG) was performed preoperatively at the postoperative 21st day and 6th month. Pathological anatomical findings at the postoperative 6th month were also evaluated. Results. All shoulder movements and muscle strengths were preserved. Neck extension, rotation movements, and flexion strengths were restricted. ENMG values were affected moderately in the early postoperative period and improved slightly in the late postoperative period. None of the patients developed shoulder syndrome or adhesive capsulitis. Conclusion. Preserving level 2b during selective neck dissection decreases trauma to the accessory nerve and improves functional results. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Ultrastructural study of the temporomandibular joint after unilateral meniscectomy in Wistar ratsJOURNAL OF ORAL REHABILITATION, Issue 10 2006D. T. MARTINI summary, Meniscectomy of the temporomandibular joint (TMJ) was frequently performed until a few years ago but now is seldom employed. This procedure induces important articular modifications but the complete extent of ultrastructural changes is still unknown. Twenty-one Wistar rats were submitted to unilateral meniscectomy. Animals were randomly divided into three groups and followed for 15, 35 or 60 days. After killing both meniscectomized and contralateral TMJ specimens were sectioned sagittally and prepared for light and scanning electron microscopy studies. Normal TMJs are characterized by glenoid fossa and condylar process with distinct conjunctive layers in which regularly arranged type 1 collagen fibres predominate. Meniscectomized animals initially exhibit a different tissue covering the eroded articular surface of the condyle with the prevalence of type 3 collagen fibres but type 1 fibres predominate in the late postoperative period. Subchondral cysts are clearly visible. A complex remodelling process of the TMJ after meniscectomy is evident with important ultrastructural modifications that may correlate to unsatisfactory clinical results. The dynamic nature of this process is also observed when specimens from different postoperative periods are compared. Surgeons should always bear in mind these alterations when indicating this procedure. [source] Etiology of Late Free Flap Failures Occurring After Hospital Discharge,THE LARYNGOSCOPE, Issue 11 2007Mark K. Wax MD Abstract Objectives: Vascular compromise of free flaps most commonly occurs in the immediate postoperative period in association with failure of the microvascular anastomosis. Rarely do flaps fail in the late postoperative period. It is not well understood why free flaps can fail after 7 postoperative days. We undertook a case review series to assess possible causes of late free flap failure. Study Design: Retrospective review at two tertiary referral centers: Oregon Health Sciences University and University of Alabama at Birmingham. Methods: A review of 1,530 flaps performed in 1,592 patients between 1998 and 2006 were evaluated to identify late flap failure. Late flap failure was defined as failure occurring after postoperative day 7 or on follow-up visits after hospital discharge. A prospective database with the following variables was examined: age, medical comorbidities, postreconstructive complications (fistula or infection), hematoma, seroma, previous surgery, radiation therapy, intraoperative findings at the time of debridement, nutrition, and, possibly, etiologies. Results: A total of 13 patients with late graft failure were identified in this study population of 1,530 (less than 1%) flaps; 6 radial forearm fasciocutaneous flaps, 2 rectus abdominis myocutaneous flaps, 4 fibular flaps, and 1 latissimus dorsi myocutaneous flap underwent late failure. The time to necrosis was a median of 21 (range, 7,90) days. Etiology was believed to possibly be pressure on the pedicle in the postoperative period in four patients (no sign of local wound issues at the pedicle), infection (abscess formation) in three patients, and regrowth of residual tumor in six patients. Loss occurring within 1 month was more common in radial forearm flaps and was presented in the context of a normal appearing wound at the anastomotic site, as opposed to loss occurring after 1 month, which happened more commonly in fibula flaps secondary to recurrence. Conclusion: Although late free flap failure is rare, local factors such as infection and possibly pressure on the pedicle can be contributing factors. Patients presenting with late flap failure should be evaluated for residual tumor growth. [source] Evaluation of findings during re-exploration for obstructive ileus after radical cystectomy and ileal-loop urinary diversion: insight into potential technical improvementsBJU INTERNATIONAL, Issue 4 2007Ioannis M. Varkarakis Authors from Greece evaluated their experience of findings during re-exploration for small bowel obstruction after radical cystectomy. They found several abnormalities, more particularly unexpected, to account for this, and drew some conclusions as to the operative technique that might help to prevent them. OBJECTIVE To retrospectively evaluate the findings during re-exploration for obstructive ileus after radical cystectomy (RC) and ileal conduit diversion. PATIENTS AND METHODS During a 12-year period, 434 patients who had RC and ileal conduit diversion were retrospectively evaluated for the diagnosis of early (,30 days after RC) or late abdominal re-exploration. The operative reports of patients requiring a second abdominal procedure were reviewed, evaluating in particular the reason for small bowel obstruction (SBO). In addition, the type of entero-enteric anastomosis and the retroperitonealization of the uretero-enteric anastomosis were compared between patients who required abdominal re-exploration for SBO and those who did not. RESULTS Abdominal re-exploration for SBO was necessary for 14 (3.2%) and 32 (7.3%) patients in the early and late postoperative period, respectively. The most common reasons for SBO were anastomotic malfunction (1.4%) and malignant recurrence (2.8%). Adhesions were the second most common cause leading to ileus in both periods (1.1% and 2.3%, respectively). When there was no retroperitonealization of the uretero-enteric anastomosis, SBO occurred more often both early and late (P = 0.06). Early anastomotic malfunction leading to SBO was more common (but not statistically significant, P = 0.06) when the entero-enteric anastomosis was hand-sutured end-to-end. CONCLUSIONS Anastomotic malfunction, bowel adhesions and internal hernias are responsible for SBO early after surgery. The above reasons, in addition to malignant recurrence, are the most common reasons for SBO in the late postoperative period. [source] One-stage reconstruction of the complex midfoot defect with a multiple osteotomized free fibular osteocutaneous flap: Case report and literature reviewMICROSURGERY, Issue 1 2010Efstathios G. Lykoudis M.D., Ph.D. Complex midfoot defects represent a reconstructive challenge since midfoot plays a key role in standing and gait. We report the case of a 27-year-old patient with a complex midfoot defect due to a high-energy gun shot injury. The defect included the tarsometatarsal complex, all three arches of the foot, and the overlying dorsal skin of the foot. Reconstruction was achieved in a single stage with a free fibular osteocutaneous flap. The fibula was osteotomized into three segments, which were used to reconstruct the bone defects, while the skin paddle of the flap was used for stable soft tissue coverage of the reconstructed bony skeleton. Early and late postoperative periods were uneventful. Bone incorporation was radiographically evident at 12 weeks, and full weight bearing was possible at 6 months postop. Final follow up, at 2 years postop, showed a very good functional and esthetic outcome. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Maximizing Breast Projection with Combined Free Nipple Graft Reduction Mammaplasty and Back-folded Dermaglandular Inferior PedicleTHE BREAST JOURNAL, Issue 3 2007Metin Gorgu MD Abstract:, Standard technique for free nipple reduction mammoplasty was described by Thorek in 1922 (1). In contrast to its effectiveness, late postoperative results included insufficient projection of the breast and the nipple,areola region. We describe a modification of this well recognized technique in order to increase central mound projection and improve nipple,areola projection by suturing the dermaglandular flap to the pectoralis major muscle by back-folding the pedicle. Twenty macromastia patients were subjected to free-nipple-graft reduction mammoplasty in combination with inferior pedicled dermaglandular reduction mammaplasty of a total of 40 breasts with this technique between years 2000 and 2004. Preoperative planning for inferior pedicled dermaglandular flap was made using the "Wise" pattern for large breasts. The variation of the technique comes from using the back-folded deepithelialized inferior pedicled dermaglandular flap for increasing the breast mound projection by fixating the demaglandular flap with absorbable sutures to the underlying pectoralis major muscle fascia and the costal cartilage pericondrium. By applying this technique, increased projection during the early preoperative and late postoperative periods are achieved, compared with patients who only underwent free-nipple- graft reduction mammoplasty. [source] | ||||||||||