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161. Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence. (Abstract)

Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence. Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse.To describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving two common transvaginal prolapse (...) or worsening buttock pain than sacrospinous suspension at 4-6 weeks postoperatively (4.6% vs. 10.5%, p=0.043) but no difference in groin or thigh pain.Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stage 2-4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4-6 weeks.Copyright © 2019 Elsevier Inc. All rights

2019 American Journal of Obstetrics and Gynecology Controlled trial quality: predicted high

162. Patient Perceptions Of Same-Day Discharge After Minimally Invasive Gynecologic And Pelvic Reconstructive Surgery. (Abstract)

Patient Perceptions Of Same-Day Discharge After Minimally Invasive Gynecologic And Pelvic Reconstructive Surgery. Studies have demonstrated that same-day discharge after minimally invasive gynecologic and pelvic reconstructive surgery is safe, cost effective, and does not result in increased readmissions when compared to inpatient surgery. However, few studies have assessed patient satisfaction with same-day discharge after minimally invasive gynecologic and pelvic reconstructive surgery (...) . Increased knowledge of patients' values allows for evidence-based, patient-centered perioperative care and guides perioperative counseling.To evaluate patient perceptions of same-day discharge after minimally invasive gynecologic and pelvic reconstructive surgery, to identify barriers to patient acceptance of same-day discharge, and to assess changes in patient acceptance before and after reading an evidence-based statement regarding same-day discharge.This is a cross-sectional survey study. All English

2019 American Journal of Obstetrics and Gynecology

163. Self-reported and performance-based outcomes following medial patellofemoral ligament reconstruction indicate successful improvements in knee stability after surgery despite remaining limitations in knee function. (Abstract)

Self-reported and performance-based outcomes following medial patellofemoral ligament reconstruction indicate successful improvements in knee stability after surgery despite remaining limitations in knee function. To evaluate short- to midterm outcomes of medial patellofemoral ligament reconstruction (MPFL) using patient-reported outcome measures and functional testing.Twenty-four patients were examined regarding knee function after MPFL reconstruction, with a mean follow-up time of 45.3 ± 18.4 (...)  months since surgery. Knee function was evaluated using the Tegner score, VAS, the knee injury and osteoarthritis outcome score (KOOS), the Lysholm score, SF-36 and EQ-5D-3L as well as functional scores. A group of uninjured persons of the same age and same gender composition was used for comparison.Eight (40%) patients managed to return to their pre-injury activity level. Five (25%) patients stated that they had experienced further patella dislocations after surgery but only two (10%) had sought

2019 Knee Surgery, Sports Traumatology, Arthroscopy

164. Acetabular reconstruction for primary and revision total hip arthroplasty using Kerboull-type acetabular reinforcement devices-case-control study with factors related to poor outcomes of surgery. Full Text available with Trip Pro

Acetabular reconstruction for primary and revision total hip arthroplasty using Kerboull-type acetabular reinforcement devices-case-control study with factors related to poor outcomes of surgery. Kerboull-type acetabular support rings (KT) and allogenic bone graft were used for severe periacetabular bone loss with primary and revision total hip arthroplasty (THA). The purpose of this case-control study is to evaluate the risk factors related to poor outcomes of surgery.Sixty patients underwent (...) infarction, smoking, American Academy of Orthopedic Surgery (AAOS) classification III or IV, bleeding>500 mL, time of surgery >3hours, high hip center-type KT, inclination of KT >45 degrees, screw angle >25 degrees, morselized bone graft, Kawanabe's classification stage 3 or 4 and revision surgery. Nineteen hips (31.6%) revealed radiological failure according to our criteria, and revision THA was performed in 2 hips (3.3%). In the statistical analysis, morselized bone graft and high hip center-type KT

2019 Medicine

165. Split-thickness skin grafts obtained from adjacent hairy skin for reconstructing auricular concave surfaces after Mohs surgery. (Abstract)

Split-thickness skin grafts obtained from adjacent hairy skin for reconstructing auricular concave surfaces after Mohs surgery. Reconstruction of large auricular defects with full-thickness skin-grafts (FTSG) is a commonly reported option, but less attention has focused on the advantages and indications of using split-thickness skin-grafts (STSG) in the ear.We sought to report our experience using STSG for repair of defects located on the auricular concave surfaces, highlighting the utility (...) complications were observed after 6-month follow-up.STSG are suitable for reconstructing concave areas in the ear, providing good cosmetic results with a simple, cost-effective and easily reproducible technique. Choosing the adjacent hairy skin as a donor area shortens the operative and postoperative time, and allows the procedure to be performed in a single surgical field.© 2019 European Academy of Dermatology and Venereology.

2019 Journal of the European Academy of Dermatology and Venereology

166. Reconstructive surgery for foot and ankle defects in pediatric patients: Comparison between anterolateral thigh perforator flaps and deep inferior epigastric perforator flaps. (Abstract)

Reconstructive surgery for foot and ankle defects in pediatric patients: Comparison between anterolateral thigh perforator flaps and deep inferior epigastric perforator flaps. Due to the delicate tissue, small blood vessels and incomplete development of interarticular ligaments, skin and soft-tissue defects of the foot and ankle in pediatric patients remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh perforator (ALTP) flap and deep inferior epigastric perforator (DIEP (...) ) flap are the most commonly used flaps for the repair of lower-extremity soft-tissue defects. The literature contains a shortage of evidence involving the differences between ALTP and DIEP flaps in the reconstruction of young patients with complex foot and ankle defects. This study was designed to determine which type of flap is better for foot and ankle repair in pediatric patients.From January 2004 to January 2018, 79 children younger than 14 years treated with DIEP flap (41 cases) or ALTP flap

2019 Injury

167. Analysis of a 7-year national online audit of the management of open reconstructive urethral surgery in men. (Abstract)

Analysis of a 7-year national online audit of the management of open reconstructive urethral surgery in men. To conduct an audit of the management of urethral pathology in men presenting for reconstructive urethral surgery in the UK.Between 1 June 2010 and 31 May 2017, data on men presenting with urethral pathologies requiring reconstruction were entered onto a secure online data platform. Surgeon-entered information was collected in 95 fields regarding the stricture aetiology, prior management (...) , mode of presentation, type of surgery and outcomes, with a potential 283 variable responses in the 95 fields. Data were analysed to compare UK practice with that reported in the contemporary literature and with guidelines.Data on 4809 men were entered by 39 centres and 50 surgeons. Field completeness was 70.7%, 74.3% and 53.7% for preoperative, operative and follow-up data, respectively. Referral for stricture reconstruction frequently followed two prior endoscopic procedures and the stricture

2019 BJU international

168. Effect of lactate versus acetate-based intravenous fluids on acid-base balance in patients undergoing free flap reconstructive surgeries. (Abstract)

Effect of lactate versus acetate-based intravenous fluids on acid-base balance in patients undergoing free flap reconstructive surgeries. Use of lactated intravenous fluids during long surgeries could cause lactate accumulation and lactic acidosis. Acetate-based solutions could be advantageous as they are devoid of lactate. The primary aim of the study was to assess the effect of use of an acetated solution or Ringer's lactate (RL) as intraoperative fluid on lactate levels in patients without (...) hepatic dysfunction undergoing prolonged surgeries.This was a prospective, randomized, controlled trial involving sixty patients belonging to American Society of Anesthesiologists Physical Status I to II undergoing major head and neck surgeries with free flap reconstruction. Patients were randomly allocated into two equal groups, Group sterofundin (SF) and Group RL. Group SF was started on acetate-based crystalloid solution (sterofundin B Braun®) and Group RL received RL intravenously at the rate

2019 Journal of anaesthesiology, clinical pharmacology Controlled trial quality: uncertain

169. Predictive Factors of Postdischarge Narcotic Use After Female Pelvic Reconstructive Surgery. (Abstract)

Predictive Factors of Postdischarge Narcotic Use After Female Pelvic Reconstructive Surgery. The aim of the study was to evaluate the association of patient factors, amount of in-hospital postoperative narcotics, and pain scores on postdischarge narcotic use (PDNU).This is a secondary analysis of a randomized controlled trial comparing a postoperative usual-care regimen with multimodal pain regimen after pelvic reconstructive surgery. This analysis evaluated patients in the multimodal arm (...) (interquartile range) PDNU of 22.5 (0-159.4) MME. After excluding postdischarge narcotic nonusers (34.8%), the median PDNU was 127.5 (22.5-180.0) MME. The median PDNU was 172.5 (150.0-180.0) MME after abdominal reconstructive surgery (n = 7), 82.5 (28.1-180.0) MME after laparoscopic reconstructive surgery (n = 22), and 37.5 (13.1-181.2) MME after vaginal reconstructive surgery (n = 14). A linear correlation was noted between the amount of postoperative narcotics used in-hospital and the amount needed

2019 Female pelvic medicine & reconstructive surgery Controlled trial quality: uncertain

170. Results of left ventricular reconstruction with and without mitral valve surgery. (Abstract)

Results of left ventricular reconstruction with and without mitral valve surgery. This study aims to compare the mid-term outcomes of left ventricular reconstruction with those of left ventricular reconstruction plus mitral valve surgery in patients with left ventricular aneurysm due to anterior myocardial infarction and moderate mitral regurgitation.A total of 523 patients (75 who underwent left ventricular reconstruction plus mitral valve surgery and 448 who underwent left ventricular (...) reconstruction) with concomitant moderate mitral regurgitation were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, stroke and subsequent mitral valve surgery, were considered secondary endpoints. Multivariable proportional hazards Cox regression models were used to assess the associations between groups and outcomes. In the sensitivity analysis, we excluded

2019 Annals of Thoracic Surgery

171. A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction. (Abstract)

A Comparison of Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Implant Breast Reconstruction. Many factors influence decisions regarding choice of breast-conserving surgery (BCS) versus mastectomy with reconstruction for early invasive breast cancer. The purpose of this study was to compare patient satisfaction following BCS and mastectomy with implant reconstruction (M-iR) utilizing the BREAST-Q patient-reported outcome measure.Women with stage I or II breast (...) cancer undergoing BCS or M-iR who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time.Our study group was composed of 3233 women; 2026 (63%) had BCS, 123 (3.8%) had nipple-sparing mastectomy, and 1084 (34%) had skin-sparing or total mastectomy. Median time from surgery to BREAST-Q was 205 days for BCS and 639 days for M

2019 Annals of Surgical Oncology

172. Antibiotic Prophylaxis During Catheter-Managed Postoperative Urinary Retention After Pelvic Reconstructive Surgery: A Randomized Controlled Trial. Full Text available with Trip Pro

Antibiotic Prophylaxis During Catheter-Managed Postoperative Urinary Retention After Pelvic Reconstructive Surgery: A Randomized Controlled Trial. To estimate whether nitrofurantoin prophylaxis decreases the incidence of culture-documented urinary tract infection for women with catheter-managed urinary retention after pelvic reconstructive surgery.This double-blind, placebo-controlled, randomized trial was conducted at five academic institutions. Women with urinary retention after surgery (...) and three among placebo recipients. In total, 52 urine cultures were obtained to evaluate symptoms of urinary tract infection, and only 27 of 52 grew at least 1,000 cfu/mL of uropathogenic bacteria.Daily nitrofurantoin did not reduce the incidence of culture-proven urinary tract infection among women with catheter-managed urinary retention after pelvic reconstructive surgery. Culture confirmed urinary tract infection in only half of symptomatic episodes.ClinicalTrials.gov, NCT02727322.

2019 Obstetrics and Gynecology

173. Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial. (Abstract)

Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial. Examine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation.Randomised controlled trial.United Kingdom (...) National Health Service.Twenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited. Following surgery participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM and completed 8 weeks of twice weekly unilateral leg press training on both limbs.Perceived knee pain, muscle pain and rating of perceived exertion (RPE) were assessed using Borg's (1998) RPE and pain scales during training. Knee pain was also

2019 Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine Controlled trial quality: uncertain

174. Nitroglycerin hypotensive effect and application in a combined surgery for reconstruction after ipsilateral maxillectomy and orbit evisceration. (Abstract)

Nitroglycerin hypotensive effect and application in a combined surgery for reconstruction after ipsilateral maxillectomy and orbit evisceration. The oral and maxillofacial region is rich in blood, and it is often difficult to stop bleeding during the operation of maxilla. Nitroglycerin is one of the most commonly used antihypertensive drugs in our hospital. We observed the effect of controlled hypotension in patients with maxillary resection. In group N, the patients had different degrees (...) of tachycardia after using nitroglycerin only. In addition, nitroglycerin has the characteristics of rapid drug resistance. A combined reversed temporal muscle flap and random forehead flap technique was performed successfully to reconstruct the large defect after ipsilateral maxillectomy and orbit evisceration. There were 43 cases used this method during 2014-2016 without large side effects.

2019 Pakistan journal of pharmaceutical sciences Controlled trial quality: uncertain

175. Modified posterior pelvic exenteration with pelvic side-wall resection requiring both intestinal and urinary reconstruction during surgery for ovarian cancer. (Abstract)

Modified posterior pelvic exenteration with pelvic side-wall resection requiring both intestinal and urinary reconstruction during surgery for ovarian cancer. Because of the anatomic proximity of the rectosigmoid to the female pelvic organs and its frequent involvement in ovarian cancer, an en bloc resection of ovarian tumors together with the uterus and rectosigmoid, also known as a modified posterior pelvic exenteration (MPPE), is frequently performed to achieve optimal cytoreduction [1 (...) reconstruction is both feasible and safe and can be considered for patients with ovarian cancer involving the pelvic side-wall. Postoperative bladder function was preserved in this patient. However, difficulty in spontaneous voiding after surgery occurs and self-intermittent catheterization is necessary in some patients undergoing a MPPE combined with pelvic side-wall resection. In the previous study, we evaluated the impact of MPPE with or without nerve preservation on bladder function of the patients

2019 Gynecologic Oncology

176. Anterior Skull Base Reconstruction following Ablative Surgery for Osteoradionecrosis: Case Report and Review of Literature. (Abstract)

Anterior Skull Base Reconstruction following Ablative Surgery for Osteoradionecrosis: Case Report and Review of Literature. Osteoradionecrosis is one of many potentially severe complications of radiotherapy for nasopharyngeal carcinoma. Osteoradionecrosis of the skull base is life-threatening due to the critical proximity of the pathological process to vital structures, for example, the intracranial cavity, the upper spine, and major blood vessels. Reconstructive options following surgical (...) debridement of the anterior skull base and upper spine osteonecrosis have been scarcely described in the literature.We present a rare case of osteoradionecrosis of the clivus and cervical vertebrae C1-C2 in a patient previously treated with chemoradiotherapy for nasopharyngeal carcinoma, presenting as severe soft tissue infection of the neck. Aggressive surgical debridement and reconstruction with a two-paddle free anterolateral thigh flap was performed using a combination of transcervical and transnasal

2019 Rhinology and Laryngology

177. Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes. (Abstract)

Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes. There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed.A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients (...) undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes.There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing

2019 Journal of Laryngology & Otology

178. Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery. (Abstract)

Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery. The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical (...) studies of the sternocleidomastoid.A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular

2019 Journal of Laryngology & Otology

179. Optimise not compromise: The importance of a multidisciplinary breast cancer patient pathway in the era of oncoplastic and reconstructive surgery. (Abstract)

and reconstructive breast surgery. We aim to describe an optimal multidisciplinary approach which balances competing risks of multimodal therapies to optimise oncological and cosmetic outcomes.Copyright © 2018 Elsevier B.V. All rights reserved. (...) Optimise not compromise: The importance of a multidisciplinary breast cancer patient pathway in the era of oncoplastic and reconstructive surgery. Modern breast cancer care is a complex multidisciplinary undertaking in which the integrated function of multiple constituent parts is critical, and where changes to one therapeutic component may profoundly influence the delivery and outcomes of another. Oncoplastic and reconstructive breast surgery has evolved in the era of longer survival rates

2019 Critical reviews in oncology/hematology

180. Does low-dose gapapentin reduce opioid use postoperatively?: A randomized controlled trial in women undergoing reconstructive pelvic surgery. (Abstract)

Does low-dose gapapentin reduce opioid use postoperatively?: A randomized controlled trial in women undergoing reconstructive pelvic surgery. Pre-emptive gabapentin has been shown to decrease postoperative pain in abdominal and vaginal hysterectomy. However, the effect of pre-emptive low-dose gabapentin has not been studied in vaginal hysterectomy combined with concomitant pelvic reconstruction.A randomized double-blind placebo-controlled trial assessed all women seen for symptomatic prolapse (...) requiring vaginal hysterectomy with concomitant pelvic reconstruction with or without midurethral sling. Gabapentin dosing was 600 mg (<65 years) or 300 mg (>65 years). The primary outcome was reduction in opioid consumption in the first 24 h after surgery. Secondary outcomes included sedation and prolongation of recovery room stay. Sample-size calculations indicated a need for 22 participants/group. Student's t test was used to compare differences in oral administration of morphine equivalents

2019 International urogynecology journal Controlled trial quality: predicted high

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