articles+ search results

Cultural diversity, Funding, Medical students, Research, Residency and internship, Surgery subspecialities, Surgery, and RD1-811

Representation of female surgical residents has slowly increased, but underrepresented in medicine (URiM) representation remains disappointingly low. National residency matching reports suggest that meaningful research experience improves surgical residency match success - therefore, formal funding opportunities and early mentorship for URiM medical students. In this study, we catalog medical student (MS) funding opportunities (funding type, eligibility by year, mission, compensation, length of commitment, number of awardees, and dollar investment amount per student) from 7 surgical departments (general surgery, thoracic surgery, vascular surgery, plastic surgery, otorhinolaryngology, orthopedic surgery, neurosurgery) within 196 US medical schools and 20 professional surgical educational organizations through manually searching web pages. We recorded 146 surgical funding opportunities from medical school surgical departments and 16 surgical funding opportunities from professional organizations. Overall, we find that medical institutions' surgical departments and professional surgical educational organizations may not be effectively utilizing recruitment strategies in MS funding opportunities.

Tracheostomy, Rummel tourniquet, ECMO, Anticoagulation, Surgery, and RD1-811

Objective: Traditionally, critically ill patients requiring prolonged mechanical ventilation benefit from a long-term airway, thus necessitating tracheostomy. The widespread application of extracorporeal membrane oxygenation (ECMO) has exponentially increased in recent years, creating a new subset of patients necessitating tracheostomy with significantly increased bleeding risk. We present a hybrid dilational tracheostomy technique utilizing a Rummel tourniquet developed at our institution to mitigate bleeding risk in patients on ECMO necessitating long-term airway. Methods: A total of 24 patients on ECMO underwent bedside hybrid dilational tracheostomy with utilization of a Rummel tourniquet from 06/2020 to 01/2022 at our institution. These patients were followed longitudinally and evaluated for postoperative bleeding. Particular attention was paid to anticoagulation regimens pre- and post-operatively. Results: The primary outcome of the study, postoperative bleeding, was observed in four of the 24 study participants (16.67 %). Each of these complications were managed with tightening of the Rummel tourniquet and application of hemostatic packing agents; no operative interventions were required. Anticoagulation was held for a mean time of 4.33 h preoperatively and 5.2 h postoperatively. Conclusions: Our data support this hybrid tracheostomy technique with the addition of a Rummel tourniquet to be a safe and effective adjunct for perioperative hemostasis in high-risk patients necessitating tracheostomy while on ECMO. While this technique was initially developed for critically ill COVID-19 patients, we believe it can be applied to all patients on ECMO to help mitigate perioperative bleeding risk.

Diabetic foot ulcer, Peripheral artery disease, Revascularization, Wound healing, Surgery, and RD1-811

Background: Revascularization is important for the healing of diabetic foot ulcers with peripheral arterial disease because it aids in the restoration of the perfusion function of the leg tissues and can reduce the risk of cardiovascular complications. However, no Indonesian studies have been identified that exclusively discuss the effectiveness of revascularization for patients with this condition. This study aimed to compare the healing rates of diabetic foot ulcers with peripheral arterial disease in patients who received or did not receive revascularization. Methods: This cohort study included diabetic foot ulcer patients with peripheral arterial disease undergoing treatment at our institution who received or did not receive revascularization based on the wound, ischemia, and foot infection (WIfI) score criteria. Wound healing was considered complete re-epithelialization within six months of the procedure or consistent epithelialization for four consecutive weeks. Patients who required amputation within six months of observation were deemed to have failed therapy. Results: Each group contained 23 patients. The revascularization group exhibited a healing rate of 78.3 % (18 patients), while the non-revascularization patients had a rate of 26.1 % (6 patients). The wounds of revascularized patients were 14.944 (1.102–202.692) times more likely to heal than those without revascularization (p

Education in trauma surgery, Surgical supporting computer system, optimizing surgical processes, Surgery, and RD1-811

Purpose: Since October 2019 a computer software named SPM (surgical process manager) is used in a Level I Trauma center. Workflows were developed for distinct surgical procedures (distal radius fractures, proximal femur fractures, ankle fractures, proximal humerus fractures and vertebral fractures). In addition, these workflows were separated in a shortened „Expert“-versions for consultants and a more detailed „Learner“- versions for residents.This investigation was intended to show, if and what kind of benefits in regard to efficiency (incision to suture and suture to incision time), education and complications a surgery supporting software can bring. Methods: SPM was used in 90 cases during October 2019 to June 2022. A control trial with 108 patients was developed, including patients of the same age, having same kind of injuries, receiving the same surgery technique without using the SPM.The software was installed on the computer in the operation room, projected on head monitors and operated by a foot pedal. Complications could also be documented using the pedal.Groups were divided in surgical procedures and fracture type, qualification of the surgeon, complications and surgery time. Surgery times were taken from the hospital computer system (SAP IS-H). A statistical analysis was performed by using the chi square and Fischer exact test with significance set at a P value

Urethral stricture, Tissue engineering, Wound healing, Swine, Surgery, and RD1-811

Background: Preclinical animal models which mimic the dimensions of long urethral strictures (>2 cm in length) encountered in the clinic are necessary to evaluate prospective graft designs for urethroplasty. The purpose of this study was to develop both male and female porcine models of long urethral strictures (∼4 cm in length) and characterize histological and functional outcomes of iatrogenic stricture formation between genders. Methods: Focal, partial thickness urethral injuries were created over 5–6 cm long segments in male and female swine (N = 4 per gender) via electrocoagulation and the degree of stricture formation was monitored for up to 6 weeks by urethroscopy and retrograde urethrography. Animals were sacrificed following stricture confirmation and histological, immunohistochemical, and histomorphometric analyses were performed on strictured and uninjured control urethral segments to profile wound healing responses. Results: Urethral stricture formation was detected in all female swine by 2 weeks and 100 % of male swine at 3.2 ± 1.8 weeks, post-operatively. The mean length of urethral strictures in both male and female swine was ∼4 cm. Substantial variations in the degree of stricture severity between sexes were observed with males exhibiting significant urethral stenosis and loss of α-smooth muscle actin+ smooth muscle bundles in comparison to controls, while females primarily displayed defects in pan-cytokeratin+ epithelia as well as functional urethral obstruction. Conclusions: Electrocoagulation injury is sufficient to produce long urethral strictures in male and female swine and the degree of stricture severity and nature of urethral obstruction was observed to be dependent on gender. Animal Protocol: AUP-19-150. Key message: Novel male and female models of long urethral strictures in swine were created to characterize histological and functional outcomes of iatrogenic stricture formation between genders.

3-D printing, Simulation, Knot-tying, Surgical education, Computer-aided design, Surgery, and RD1-811

Introduction: Clinical simulators are an important resource for medical students seeking to improve their fundamental surgical skills. Three-dimensional (3-D) printing offers an innovative method to create simulators due to its low production costs and reliable printing fidelity. We aimed to validate a 3-D printed knot-tying simulator named Nodo-Tie. Methods: We designed a 3-D printed knot-tying simulator integrated with a series of knot-tying challenges and a designated video curriculum made accessible via a quick-response (QR) code. The Nodo-Tie, which costs less than $1 to print and assemble, was distributed to second-year medical students starting their surgical clerkship. Participants were asked to complete a survey gauging the simulator's usability and educational utility. The time between simulator distribution and survey completion was eight weeks. Results: Students perceived the Nodo-Tie as easy-to-use (4.6 ± 0.8) and agreed it increased both their motor skills (4.5 ± 0.9) and confidence (4.5 ± 0.8) for tying surgical knots in the clinical setting. Many students agreed the Nodo-Tie provided a stable, durable surface for knot-tying practice (83.7%, n = 41) and that they would continue to use it beyond their participation in the study period (91.7%, n = 44). Discussion: Medical students found this interactive, 3-D printed knot-tying simulator to be an effective tool to use for self-directed development of their knot-tying skills. Given the Nodo-Tie's low cost, students were able to keep the Nodo-Tie for use beyond the study period. This increases the opportunity for students to engage in the longitudinal practice necessary to master knot-tying as they progress through their medical education. Key messages: Clinical simulators provide proactive learners with reliable, stress-free environments to engage in self-directed surgical skills development. The Nodo-Tie, a 3-D printed simulator, serves as a cost-effective, interactive tool for medical students to develop their knot-tying abilities beyond the clinical setting.

Hepatoblastoma, Anterior approach, Liver hanging maneuver, Parenchymal sparing anatomical liver resection, Surgery, and RD1-811

Background: The principle of hepatoblastoma (HB) treatment is complete resection. The removal of tumor-bearing section(s) or hemiliver is widely accepted. However, neither the standardized anterior approach for right hepatectomy nor parenchymal sparing anatomical liver resection has been described for HB. Methods: We retrospectively reviewed the clinical course of two pediatric HB patients who underwent extended right hepatectomy using the anterior approach with the liver hanging maneuver and one who underwent parenchymal sparing anatomical liver resection of S4 apical+S8 ventral/dorsal+S7. The critical aspects of surgical techniques are described in detail. Results: In all three patients, R0 resection was achieved without complications and are currently alive without recurrence after an average follow-up of 23 months. Intraoperative cardiac hemodynamics were stable, even in a trisomy 18 patient with cardiac disease. Conclusions: Our findings suggest that these innovative techniques established in adults are safe and feasible for HB in children. These techniques also allow optimal anatomical liver resection to accomplish curative surgery while maintaining the functional reserve of the remnant liver.

Pancreatic surgery, Volume:outcome relationship, Regionalization, Surgery, and RD1-811

Introduction: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Some have used these differences to suggest that regionalization of PC surgery would optimize patient outcomes and expenditures. Methods: A Markov model was created to evaluate 30-day mortality, 30-day complications, and 30-day costs. The differences in these outcome measures between the current and future states were measured to assess the population-level benefits of regionalization. A sensitivity analysis was performed to evaluate the impact of variations of input variables in the model. Results: Among 5958 new cases of pancreatic cancer in California in 2021, a total of 2443 cases (41 %) would be resectable; among patients with resectable PC, a total of 977 (40 %) patients would undergo surgery. In aggregate, HVC and LVC 30-day postoperative complications occurred in 364 patients, 30-day mortality in 35 patients, and healthcare costs expended managing complications were $6,120,660. In the predictive model of complete regionalization to only HVC in California, an estimated 29 fewer complications, 17 fewer deaths, and a cost savings of $487,635 per year would occur. Conclusions and relevance: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Complete regionalization of pancreatic cancer surgery predicted benefits in mortality, complications and cost, though implementing this strategy at a population-level may require investment of resources and redesigning care delivery models.

cholesteatoma, carcinoma, temporal, malignancy, Otorhinolaryngology, RF1-547, Surgery, and RD1-811

AbstractCholesteatoma and the ensuing chronic inflammation may promote temporal bone tumorigenesis. Our patient is an 80-year-old female who had undergone left ear surgery 72 years prior. She presented with a 3-month history of left facial asymmetry associated with otalgia. Patient had been having intermittent discharge from the left ear since her first ear surgery but worsened in the recent 3 months. The patient underwent mastoid exploration. Histopathological study showed no evidence of dysplasia or malignancy. At one-year post surgery, the patient was noted to have soft tissue swelling in the mastoid region which was reported as squamous cell carcinoma. Scans showed extensive disease with possible extradural involvement. Therefore, she was given radical radiotherapy. Chronic ear infection, especially cholesteatoma, may progress to temporal bone malignancy. If the tumour is advanced or the patient’s condition is unfavourable for the surgery, radiotherapy can be a useful modality of treatment.

Surgical fatigue syndrome, Surgical ergonomic, Surgical performance, Work-related musculoskeletal disorders, Musculoskeletal discomfort, Surgery, and RD1-811

Background: Surgical fatigue syndrome (SFS) is a frequent, but underestimated, entity that occurs during laparoscopic surgeries. It could impair surgical outcomes, patient safety, and surgeon health. Furthermore, current surgical education lacks effective interventions to avoid it. Discomfort represents the most common manifestation and includes musculoskeletal fatigue, numbness, or frank pain. The most common affected sites are the back neck, dominant hand shoulder, and high or low back. We propose an integral intervention (surgeon posture, instruments/devices design & use and discomfort improvement) that prevents or mitigates SFS. Methods: An experimental study was conducted on 57 general surgery residents and general surgeons. Participants in the experimental and control group executed standardized laparoscopic knots in a simulator and knowledge, body discomfort, and posture/ergonomic risk was evaluated before and after intervention application. Results: A statistically significant decrease in discomfort intensity was found in the experimental group. Also, discomfort presentation by the anatomic site diminishes and surgical performance improves. Conclusions: Intervention prevents or mitigates discomfort associated with muscle-skeletal component of SFS. ACGME competency: Practice Based-Learning and Improvement.

Injury, Hand, Prevention, National, Surgery, and RD1-811

Summary: Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of preventable wrist and hand injuries (as defined by the core research team) at a national level in the UK. 28 UK hospitals undertook a service evaluation of all hand trauma cases presenting to their units over a 2 week period in early 2021 identifying demographical and aetiological information about injuries sustained. 1909 patients were included (184 children) with a median age of 40 (IQR 25-59) years. The commonest five types of injury were fractures of the wrist; single phalangeal or metacarpal fractures; fingertip injuries; and infection, with the most common mechanisms being mechanical falls and manual labour. This is the first extensive survey of preventable hand injuries in the UK, identifying a need for further work into prevention to reduce healthcare burden and cost. 50% of injuries presenting to hand surgeons are preventable, with the most common injuries being single fractures of the wrist, phalanx and metacarpal. Few preventable injuries were related to alcohol or narcotic intoxication. Further research is needed to identify how to initiate injury prevention measures for hand injuries, particularly focussed towards hand fracture prevention.

Tuberculosis, cholesteatoma, chronic mastoiditis, Otorhinolaryngology, RF1-547, Surgery, and RD1-811

AbstractTuberculous otitis media, caused by Mycobacterium tuberculosis, is a chronic bacterial infection that affects the middle ear structures. Diseases with polymorphous and insidious clinical features can make diagnosis difficult and delay treatment. Herein we report a case of chronic tuberculous otitis media associated with cholesteatoma, highlighting the main factors that led to the diagnosis. Further, this report aimed to highlight the particularities in the clinical and surgical treatment of the case, given the association with chronic cholesteatomatous otitis media. This descriptive research, with qualitative analysis, was carried out at the Department of Otorhinolaryngology of the Hospital de Reabilitação de Anomalias Craniofaciais in São Paulo, Brazil. This study highlights the importance of investigating tuberculosis as a differential diagnosis of granulomatous diseases of the middle ear and temporal bone, given the risk of serious and irreversible complications as the disease progresses.

Inguinal hernia, Laparoscopic, Mesh fixation, Meta-analysis, Surgery, and RD1-811

Background: Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods: The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results: Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion: Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.

Cross-leg flap, Reconstruction, Classification, Perforator flap, Axial flap, Free flap, Surgery, and RD1-811

Background: Cross-leg (CL) flap procedures have a long history in reconstructive surgery, having been described for the first time in 1854. The application of these flaps can potentially solve many reconstructive issues with satisfactory outcomes. Patients and methods: During our research into the history and development of CL flaps, we identified a variety of flaps for which a classification system can be proposed based on blood supply and flap modifications. In this study, 10 patients with different complaints were managed using posterior tibial artery (PTA) perforator CL flap and superiorly based sural CL flap with satisfactory outcomes. Results: All flaps survived and healed smoothly; consequently, the flaps provided stable coverage, and the donor sites were reconstructed using skin grafts, which provided satisfactory results to the patients and/or their guardians. Conclusion: To our knowledge, this is the first study to propose a simple classification and group different types of flaps mentioned in the literature under one category. CL flaps are a common reconstructive option for patients with injuries that limit their mobility.

Immediate autologous breast reconstruction, Post-mastectomy radiation therapy, Patient-reported outcomes, BREAST-Q, Surgery, and RD1-811

Background: The majority of English literature has reported on the somewhat conflicted outcomes of the effect of radiotherapy on immediate breast reconstruction. However, data specifically related to patients of Asian descent has been scarce. This retrospective study aims to shed light on this topic to aid in the management of this group of patients. Methods: All patients who received immediate free perforator flap-based breast reconstruction under a single surgeon over a 10-year period were included in the study. Patient characteristics, oncological and surgical data were collected. Patients were divided into post-mastectomy radiotherapy (PMRT) and non-PMRT groups. The final aesthetic outcome was assessed by a surgeon-reported outcome questionnaire. Patient satisfaction and psychological outcomes were assessed using validated patient-reported outcome (PRO) questionnaire (BREAST-Q), breast reconstruction, and postoperative module. Results: A total of 101 women, with an average age of 44.7 ± 8.4 underwent perforator flap-based reconstruction. Fifteen patients received PMRT, with remaining 86 patients in the non-PMRT group. The mean duration of follow-up was over 5 years (p = 0.514). The recurrence rate was acceptable in the PMRT group (3/15, p = 0.129). There were no significant differences in complication rates between the two groups (p = 1.000). The aesthetic outcomes were comparable (p = 0.342). PRO appears to be lower in the PMRT group. Conclusions: Immediate breast reconstruction with PMRT in the local patient cohort is oncologically safe, acceptable complication profile, revision rate, and aesthetic outcome. PRO showed lower scores in several categories, which differ from normative data generated in the Western population. Further studies will need to examine the confounding effects of radiation in this specific population.

Breast, Intermuscular lipoma, Giant lipoma, Pectoral muscles, Soft tissue tumor, Surgical excision, Surgery, and RD1-811

A giant intermuscular lipoma, an exceedingly rare occurrence, constitutes a non-malignant neoplasm originating from the mesodermal germ cell layer, with dimensions surpassing 10 cm. Its differentiation from liposarcoma and other malignant tumours is imperative. We present a case involving a 75-year-old woman who initially raised suspicions of liposarcoma due to pronounced enlargement and fullness in the upper quadrants of the left breast. After comprehensive imaging evaluations, the identification of a sizable BI-RADS 4a lesion positioned between the major and minor pectoral muscles of the left breast was found. The definitive diagnosis of an exceedingly rare giant intramuscular lipoma was validated solely subsequent to the surgical excision of the lipoma, through histological analysis.

Headache surgery, Nerve decompression surgery, Headache, Treatment delay, Surgery, and RD1-811

Summary: Background: Although headache surgery has been shown to be an effective treatment option for refractory headache disorders, it has not been included as part of the headache disorder management algorithm by non-surgical providers. This study aims to evaluate the delay in surgical management of patients with headache disorders. In addition, a cost comparison analysis between conservative and operative treatment of headache disorders was performed, and the surgical outcomes of headache surgery were reported. Methods: Among 1112 patients who were screened, 271 (56%) patients underwent headache surgery. Data regarding the onset of headache disorder and pre- and postoperative pain characteristics were prospectively collected. To perform a cost comparison analysis, direct and indirect costs associated with the conservative treatment of headache disorders were calculated. Results: The median duration between onset of headache disorder symptoms and headache surgery was 20 (8.2-32) years. The annual mean cost of conservative treatment of headache disorders was $49,463.78 ($30,933.87-$66,553.70) per patient. Over the 20-year time period before surgery, the mean cost was $989,275.65 ($618,677.31-$1,331,073.99). In comparison, the mean cost of headache surgery was $11,000. The median pain days per month decreased by 16 (0-25) (p

Ectopic replantation, Free flap, Mini ex fixator, Finger implantation, Crush injury, Surgery, and RD1-811

Retrieval of four finger injury at proximal stump amputation with segmental injury along with soft tissue defect and impending compartment syndrome continues to be challenge for the surgeon. Immediate transplant considering temporary ectopic foster as a practical option in special case. We describe temporary ectopic finger implant for crush injury at Metacarpophalangeal (MCP level) with hand torsion along with forearm compartment was fostered to Dorsum of the foot. The torsion fingers was temporary fixed with mini external fixator for stabilization as salvage, ALT free flap was used to cover soft tissue defect of the hand. Replantation of survived figure was performed using the long pedicle to anatomical site without crushing the MCP joint to allow for later tendon transfer for finger. Satisfactory function regained with no foster site (foot) complication like pain or disability. The author validated ectopic foster for amputee as and procedure of choice for salvage of extremity under special circumstances.

Bennett's fracture, Closed reduction, Open reduction internal fixation, Thumb, Carpometacarpal joint, Surgery, and RD1-811

Background: First described in 1882, Bennett's fracture is an intra-articular fracture of the first metacarpal associated with a dislocation of the carpometacarpal joint. Usually, open reduction internal fixation is used to manage such fractures. However, closed reduction has shown good outcomes recently. This meta-analysis compares closed reduction to open reduction internal fixation in the management of Bennett's fracture. Methods: PubMed, Cochrane, and Google Scholar (pages 1–20) were searched until August 2023. The clinical outcomes consisted of post-traumatic arthritis, grip and pinch strengths, range of motion, functional scores, and mean adduction deformity. Results: Six retrospective studies were included in this meta-analysis. Our results show higher grip and pinch strengths, better extension and flexion of the thumb, and lower mean adduction deformity in the open reduction internal fixation group. Conclusion: Higher grip and pinch strengths, better extension and flexion of the carpometacarpal joint, and a smaller mean adduction deformity of the thumb in the open reduction internal fixation group. No differences were seen in the remaining outcomes. However, a higher rate of complications is associated with open reduction internal fixation. Nevertheless, more randomized controlled studies are needed to confirm such results. Level of evidence: III

Amputation, Peripheral nerve, Regenerative peripheral nerve interface, Targeted muscle reinnervation, Surgery, and RD1-811

TMR (targeted muscle reinnervation) or RPNI (regenerative peripheral nerve interface) have been the standard after nerve injuries. In this case report, we explain our approach in combining these two techniques (TMRpni) for a patient undergoing left above-the-knee amputation. Using this method, both phantom and nerve pain were reduced in our patient's case. As this technique becomes more well understood and widely adopted, amputee patients may achieve a greater quality of life post operation.