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Preoperative Planning (preoperative + planning)
Selected AbstractsPreoperative planning for free-tissue transferMICROSURGERY, Issue 5 2005Anthony A. A. Smith M.D. Preoperative planning is of paramount importance in the surgical teaching of free-tissue transfer. Preoperative planning begins with the initial patient evaluation and continues to the point of successful free-tissue transfer. A detailed preoperative plan allows even the neophyte microsurgeon to anticipate operative difficulties before they occur, and to have contingency plans for nearly all intraoperative scenarios. © 2005 Wiley-Liss, Inc. Microsurgery 25:365,372, 2005. [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] Modifying techniques in deep inferior epigastric artery perforator flap harvest with the use of preoperative imagingANZ JOURNAL OF SURGERY, Issue 9 2009Warren M. Rozen Abstract New techniques in the harvest of deep inferior epigastric artery perforator (DIEP) flaps have become introduced as a result of modern imaging technologies that can allow virtual surgery to be achieved preoperatively. With computed tomographic angiography, individual anatomy can be appreciated in detail to a level not previously appreciated. These imaging techniques can be successfully used to guide DIEP flap surgery. ,Optimal' perforators can be selected based on size, location, intramuscular and subcutaneous course, and their association with motor nerves. Flap design can be safely achieved based on the cutaneous distribution of perforators. Abdominal wall closure can be improved based on the abdominal contour seen with imaging. Preoperative planning can aid patient selection, plan all aspects of the operative technique, reduce operating time and improve operative outcomes. [source] Distributed source modeling of language with magnetoencephalography: Application to patients with intractable epilepsyEPILEPSIA, Issue 10 2009Carrie R. McDonald Summary Purpose:, To examine distributed patterns of language processing in healthy controls and patients with epilepsy using magnetoencephalography (MEG), and to evaluate the concordance between laterality of distributed MEG sources and language laterality as determined by the intracarotid amobarbital procedure (IAP). Methods:, MEG was performed in 10 healthy controls using an anatomically constrained, noise-normalized distributed source solution (dynamic statistical parametric map, dSPM). Distributed source modeling of language was then applied to eight patients with intractable epilepsy. Average source strengths within temporoparietal and frontal lobe regions of interest (ROIs) were calculated, and the laterality of activity within ROIs during discrete time windows was compared to results from the IAP. Results:, In healthy controls, dSPM revealed activity in visual cortex bilaterally from ,80 to 120 ms in response to novel words and sensory control stimuli (i.e., false fonts). Activity then spread to fusiform cortex ,160,200 ms, and was dominated by left hemisphere activity in response to novel words. From ,240 to 450 ms, novel words produced activity that was left-lateralized in frontal and temporal lobe regions, including anterior and inferior temporal, temporal pole, and pars opercularis, as well as bilaterally in posterior superior temporal cortex. Analysis of patient data with dSPM demonstrated that from 350 to 450 ms, laterality of temporoparietal sources agreed with the IAP 75% of the time, whereas laterality of frontal MEG sources agreed with the IAP in all eight patients. Discussion:, Our results reveal that dSPM can unveil the timing and spatial extent of language processes in patients with epilepsy and may enhance knowledge of language lateralization and localization for use in preoperative planning. [source] Accuracy assessment of computer-assisted flapless implant placement in partial edentulismJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2010N. Van Assche Van Assche N, van Steenberghe D, Quirynen M, Jacobs R. Accuracy assessment of computer-assisted flapless implant placement in partial edentulism. J Clin Periodontol 2010; 37: 398,403. doi: 10.1111/j.1600-051X.2010.01535.x Abstract Aim: To assess the accuracy of implants placed flapless by a stereolithographic template in partially edentulous patients. Material and Methods: Eight patients, requiring two to four implants (maxilla or mandible), were consecutively recruited. Radiographical data were obtained by means of a cone beam or a multi-slice CT scan and imported in a software program. Implants (n=21) were planned in a virtual environment, leading to the manufacture of one stereolithographic template per patient to guide the implant placement in a one-stage flapless procedure. A postoperative cone beam CT was performed to calculate the difference between virtual implant (n=21) positions in the preoperative planning and postoperative situation. Results: A mean angular deviation of 2.7° (range 0.4,8, SD 1.9), with a mean deviation at the apex of 1.0 mm (range 0.2,3.0, SD 0.7), was observed. If one patient, a dropout because of non-conformity with the protocol, was excluded, the angular deviation was reduced to 2.2° (range 0.6,3.9, SD 1.1), and the apical deviation to 0.9 mm (range 0.2,1.8). Conclusion: Based on this limited patient population, a flapless implant installation appears to be a useful procedure even when based on accurate and reliable 3D CT-based image data and a dedicated implant planning software. [source] Tracheobronchography and angiocardiography of paediatric cardiac patients with airway disordersJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2002YF Cheung Objective: We report our experience in combining tracheobronchography and angiocardiography in the assessment of a selected cohort of paediatric cardiac patients with problematic airway disorders. Methodology: The clinical records of 11 patients who underwent 17 studies at a median age of 5.5 months (range 3 months to 10.8 years) were reviewed. Tracheobronchography and angiocardiography were performed under general anaesthesia using a non-ionic contrast agent. The findings were compared with those of flexible bronchoscopy and magnetic resonance imaging (MRI). Results: Seven patients had cardiac lesions associated with vascular anomalies potentially compressing the airway, while four had no identifiable aberrant or enlarged vessels. All examinations but one were performed without complications. Tracheobronchography demonstrated extrinsic vascular compression with secondary airway malacia in three (27%), intrinsic tracheobronchial stenosis in five (45%), and airway malacia in three patients (27%). Precise measurement of the airway calibre and real-time fluoroscopic monitoring facilitated transcatheter tracheobronchial interventions (six balloon dilations, three stent implantations) in four patients. In conjunction with angiocardiography, cine-tracheobronchography provided detailed information on the spatial relationship between vascular and airway structures in all patients; allowed dynamic assessment of airway malacia; and facilitated preoperative planning in six patients. In contrast, bronchoscopy failed to differentiate malacia from extrinsic compression in four patients (36%), while MRI, performed in six patients, was unsatisfactory in one due to a motion artefact and failed to diagnose airway malacia and extrinsic compression in three patients. Conclusions: Tracheobronchography is relatively safe in paediatric cardiac patients. Combined tracheobronchography and angiocardiography, a less operator-dependent imaging modality compared to bronchoscopy and MRI, delineated the airway and vascular anatomy in detail; facilitated preoperative planning; and permitted transcatheter tracheo-bronchial interventions. The dynamic capability of tracheobronchography supplements that of flexible bronchoscopy and MRI in the diagnosis of airway malacia. [source] Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforatorsMICROSURGERY, Issue 5 2008BMedSc, PGDipSurgAnat, W. M. Rozen MBBS Preoperative imaging of the donor site vasculature for deep inferior epigastric artery (DIEA) perforator flaps and other abdominal wall reconstructive flaps has become more commonplace. Abdominal wall computed tomography angiography (CTA) has been described as the most accurate and reproducible modality available for demonstrating the location, size, and course of individual perforators. We drew on our experience of 75 consecutive patients planned for DIEA-based flap surgery undertaking CTA at a single institution. Seven of these cases have been reported to highlight the utility of CTA for preoperative planning, emphasizing the unique information supplied by CTA that may influence operative outcome. Among all cases that underwent preoperative imaging with CTA, there was 100% flap survival, with no partial or complete flap necrosis. We found that in three of the cases described, the choice of operation was necessarily selected based on CTA findings (DIEA perforator flap, transverse rectus abdominis myocutaneous flap, and superficial superior epigastric artery flap). In addition, three cases demonstrate that CTA findings may dictate the decision to operate at all, and one case demonstrates the utility of CTA for evaluating the entire abdominal contents for comorbid conditions. Our experience with CTA for abdominal wall perforator mapping has been highly beneficial. CTA may guide operative technique and improve perforator selection in uncomplicated cases, and in difficult cases it can guide the most appropriate operation or indeed if an operation is appropriate at all. This is particularly the case in the setting of comorbidities or previous abdominal surgery. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Large recurrent plexiform neurofibroma of the foot and ankleMICROSURGERY, Issue 1 2004Lee L.Q. Pu M.D., Ph.D. Plexiform neurofibroma often causes significant pain, deformity, and functional problems in the affected part of the body. Surgical management of the condition can be challenging, and local recurrence is common because of inadequate resection of the tumor. One patient with a large recurrent plexiform neurofibroma of the foot and ankle was treated successfully with a complete resection of the tumor, followed by a free latissimus dorsi muscle transfer with a skin graft for soft-tissue reconstruction. The patient has regained good contour of the foot and ankle, and has been symptom-free with no evidence of local recurrence in the affected area for 18 months. The authors believe that thorough preoperative planning and state-of-the-art reconstructions, as described here, are the keys to their success. © 2003 Wiley-Liss, Inc. [source] Thoracic Aortic Aneurysms and Dissections: Endovascular TreatmentMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 3 2010Donald T. Baril MD Abstract The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256,269, 2010. © 2010 Mount Sinai School of Medicine [source] Resection of liver metastases from colorectal cancer: does preoperative chemotherapy affect the accuracy of PET in preoperative planning?ANZ JOURNAL OF SURGERY, Issue 5 2009Sam Adie Abstract Background:, Preoperative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of preoperative chemotherapy, which has marked biochemical and physical effects on the liver. Integrated fluoro-deoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) has applications for detecting extrahepatic disease. The aim of the present study was to investigate FDG-PET/CT as a preoperative planning tool for detecting liver lesions in patients with and without preoperative chemotherapy. Methods:, Patients who had resection of hepatic colorectal metastases between January 2004 and June 2006 were included. Patients were divided into those who received preoperative chemotherapy and those who did not. Malignant hepatic lesions found on each scan were compared with those found on histopathology, intraoperative examination and/or intraoperative ultrasound. Accurate scans (scan lesions corresponded to true lesions), false positives (scan lesions detected at least one non-lesion) and false negatives (scan lesions missed at least one true lesions) were recorded. Results were also compared on a per lesion basis. Results:, A total of 21 patients had preoperative FDG-PET/CT scans with preoperative chemotherapy and 53 without. Accurate tests were six (29%) for the chemotherapy group versus 28 (53%) for the non-chemotherapy group (P= 0.06). Notably, there were 11 (52%) underestimations in the chemotherapy group versus 18 (34%) in the non-chemotherapy group. A total of 1.7 lesions were missed per patient in the chemotherapy group versus 0.7 in those who did not receive chemotherapy. Conclusion:, Preoperative assessment with FDG-PET/CT is not useful for hepatic colorectal metastases, particularly when preoperative chemotherapy is used, with a trend towards underestimation of lesions. [source] The PediPump: A Versatile, Implantable Pediatric Ventricular Assist Device,Update IVARTIFICIAL ORGANS, Issue 11 2009Brian W. Duncan Abstract Cleveland Clinic's PediPump (Cleveland, OH, USA) is a ventricular assist device designed for the support of pediatric patients. The PediPump is a mixed-flow ventricular assist device with a magnetically suspended impeller measuring 10.5 mm in diameter by 64.5 mm in length. Progress and achievements for the PediPump program are considered according to the development project's three primary objectives: Basic engineering: along with size reductions, substantial design improvements have been incorporated in each design iteration including the motor, magnetic bearings, axial touch points, and heat transfer path; Anatomic modeling and device fitting studies: Techniques based on computed tomography and magnetic resonance imaging have been developed to create three-dimensional anatomic-modeling and device-fitting tools to facilitate device implantation and to assist in preoperative planning. For in vivo testing, to date, six acute (6-h duration) and nine chronic (30-day target duration) implantations have been performed in sheep; the implantation of the PediPump appears to be relatively easy with excellent hemodynamic performance and minimal hemolysis during support. Cleveland Clinic's PediPump program supported by the National Heart, Lung and Blood Institute's Pediatric Circulatory Support Program has led to the development of a pediatric ventricular assist device that has satisfactory performance in preclinical evaluation and appears to be ready to support a program of clinical testing. [source] The use of vein grafts in the repair of the inferior alveolar nerve following surgeryAUSTRALIAN DENTAL JOURNAL, Issue 2 2010RHB Jones Abstract Damage to the branches of the trigeminal nerve can occur as a result of a variety of causes. The most common damage to all divisions of this nerve occurs as a result of facial trauma. Unfortunately, iatrogenic damage to the inferior alveolar branch of the mandibular division of the trigeminal nerve is common because of its anatomical position within the mandible and its closeness to the teeth, particularly the third molar. It has been reported there is an incidence of approximately 0.5% of permanent damage to the inferior alveolar nerve following third molar removal. Extraction of other teeth within the mandible carries a lower incidence of permanent damage. However, damage can still occur in the premolar area, where the nerve exits the mandible via the mental foramen. Dental implants are a relatively new but increasing cause of damage to this nerve, particularly if the preoperative planning is inadequate. CT scanning is important for planning the placement of implants if this damage is to be reduced. Primary repair of the damaged nerve will offer the best chance of recovery. However, if there is a gap, and the nerve ends cannot be approximated without tension, a graft is required. Traditionally, nerve grafts have been used for this purpose but other conduits have also been used, including vein grafts. This article demonstrates the use of vein grafts in the reconstruction of the inferior dental branch of the mandibular division of the trigeminal nerve following injury, in this case due to difficulty in third molar removal, following sagittal split osteotomy and during the removal of a benign tumour from the mandible. In the five cases presented, this technique has demonstrated good success, with an acceptable return of function occurring in most patients. [source] Three-dimensional CT angiography: A new technique for imaging microvascular anatomyCLINICAL ANATOMY, Issue 2 2007Ashley P. Tregaskiss Abstract To date there has been no satisfactory research method for imaging microvascular anatomy in three dimensions (3D). In this article we present a new technique that allows both qualitative and quantitative examination of the microvasculature in 3D. In 10 fresh cadavers (7 females, 3 males, mean age 68 years), selected arteries supplying the abdominal wall and back were injected with a lead oxide/gelatin contrast mixture. From these regions, 30 specimens were dissected free and imaged with a 16-slice spiral computed tomographic (CT) scanner. Using three-dimensional CT (3D-CT) angiography, reconstructions of the microvasculature of each specimen were produced and examined for their qualitative content. Two calibration tools were constructed to determine (1) the accuracy of linear measurements made with CT software tools, and (2) the smallest caliber blood vessel that is reliably represented on 3D-CT reconstructions. Three-dimensional CT angiography produced versatile, high quality angiograms of the microvasculature. Correlation between measurements made with electronic calipers and CT software tools was very high (Lin's concordance coefficient, 0.99 (95% CI 0.99,0.99)). The finest caliber of vessel reliably represented on the 3D-CT reconstructions was 0.4 mm internal diameter. In summary, 3D-CT angiography is a simple, accurate, and reproducible method that imparts a much improved perception of anatomy when compared with existing research methods. Measurement tools provide accurate quantitative data to aid vessel mapping and preoperative planning. Further work will be needed to explore the full utility of 3D-CT angiography in a clinical setting. Clin. Anat. 20:116,123, 2007. © 2006 Wiley-Liss, Inc. [source] The surgical anatomy of the ansa pectoralisCLINICAL ANATOMY, Issue 8 2006Marios Loukas Abstract Detailed anatomical knowledge of the pectoral nerves is of clinical importance in surgeries as diverse as limb neurotization, mastectomy, orthopedic procedures and operations related to trauma. The brachial plexus of 200 cadavers were examined in an attempt to clarify the normal origins, courses and variations of the nerves with special emphasis on the ansa pectoralis (AP). In 75% the MPN arose from the anterior division of the inferior trunk of the brachial plexus and in 25% it arose from the medial cord. In 40% of specimens, the LPN arose from a single contributing nerve (anterior division of the superior trunk, 11%; anterior division of the middle trunk 18%; lateral cord, 11%). In the remaining 60% of specimens, the LPN arose from the fusion of two rootlets derived variably from the anterior divisions of the superior and middle trunks and the lateral cord. A single AP was found to be present bilaterally in 200 (100%) of the specimens. Classification of the AP was based upon its origin from the upper or lower rootlet of the LPN, the LPN itself, or from the deep branch of the LPN. AP-1 (42%) arose from the deep branch of the LPN; AP-2 (28%) arose directly from the LPN; AP-3 (25%), arose from the lower rootlets of the LPN and rarely, the AP arose from the upper rootlet of the LPN and crossed posterior to the lower rootlet to communicate with the MPN (AP-4, 5%). Irrespective of the aforementioned types, the AP was found to be present, crossing the second segment of the axillary artery in 90% of the specimens. These results could prove useful during the preoperative planning of neurotization and other surgical procedures involving the axilla. Clin. Anat. 19:685,693, 2006. © 2006 Wiley-Liss, Inc. [source] Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone-beam computed tomographyCLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2010Nikos Makris Abstract Objectives: To assess the visibility and the course of the incisive canal and the visibility and the location of the lingual foramen using cone-beam computed tomography (CBCT). Methods: In total, 100 CBCT examinations of patients for preoperative planning were used for this study. The examinations were taken using the NewTom 3G CBCT unit, applying a standardized exposure protocol. Image reconstruction from the raw data was performed using the NewTom software. Three experts were asked to assess the visibility of the incisive canal using a four-point rating scale. The position of the incisive canal was recorded in relation to the lower, buccal and lingual border of the mandible using the application provided by the CBCT software. Results: The incisive canal was definitely visible in 83.5% of the scans and the mean endpoint was approximately 15 mm anterior to the mental foramen. The mean distance from the lower border of the mandible was 11.5 mm and its course was closer to the buccal border of the mandible in 87% of the scans. The lingual foramen was definitely visible in 81% of the scans. Conclusions: The high detection rate of the incisive canal and the lingual foramen in the anterior region of the mandible using CBCT indicates the potentional high preoperative value of CBCT scan for surgical procedures in the anterior mandible. To cite this article: Makris N, Stamatakis H, Syriopoulos K, Tsiklakis K, van der Stelt PF. Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone-beam computed tomography. Clin. Oral Impl. Res. 21, 2010; 766,771. doi: 10.1111/j.1600-0501.2009.01903.x [source] Precision of transfer of preoperative planning for oral implants based on cone-beam CT-scan images through a robotic drilling machineCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2002An in vitro study Abstract: In this study, an image-guided system for oral implant placement was assessed. A specially designed mechanical tool has been elaborated to transfer the preoperative implant axis planned on 3-dimensional imagery into a surgical template by a numerically controlled drilling machine. The main drawback of image-guiding systems is the use of preoperative computed tomography, which is expensive and delivers high radiation doses. Therefore, in this study the image-guiding system was coupled with a cone-beam tomograph that significantly decreased both cost and radiation doses. Three edentulous models were used. To determine the accuracy of the system, the ability of a 1.8-mm diameter drill to enter a 2.0-mm diameter, 10-mm-long titanium tube inserted on the model with no contact was verified. Because the drill entered the tubes with no contact and went beyond the end of the tube, the transfer error was less than 0.2 mm for translation and less than 1.1° for rotation. The method presented here is low cost and high precision compared to other technological solutions such as tracking. Further assessment in the surgical field should lead to daily use of this system for flapless surgery, to prepare a prosthesis prior to surgery for immediate loading, to reduce risk of injuring critical anatomical structures and to eliminate manual placement error. [source] | ||||||||||