Surgeries, Volume 5, Issue 1 (March 2024) – 12 articles

This systematic review aimed to identify, evaluate, and summarize the results of relevant studies on radicular prominence and its relationship with gingival recessions. This review was conducted according to the PRISMA (Preferred Reporting Reviews and Meta-Analysis) guidelines, and the focused PICO question was “In teeth with vestibular site-specific root or alveolar bone prominence, what are the chances that this will lead to gingival recession or difficulty in root coverage procedures, compared to teeth correctly positioned in the alveolar bone or without anatomical root prominence?”. A search was carried out on three databases: Embase, PubMed/MedLine, and Wiley Library. This initial search was complemented with manual research. It included any clinical study, such as a randomized clinical trial, controlled clinical trial, prospective/retrospective clinical study, case series, or case report, published in English from January 2012 to December 2023, which reported any involvement of the root/bone prominence approach. The exclusion criteria were clinical studies without report results/details of the case(s), studies based on questionnaires, editorial letters, any review, in vitro/in silica and animal studies, and interviews. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was applied for quality assessment. A total of 163 articles were found, but only three articles were included (k = 0.98). The included studies observed negative correlations when comparing the variables root prominence with linear root coverage, root surface area covered, and linear tissue thickness gain. It suggested a significant reduction in root coverage for prominences greater than 1 mm; therefore, relevant keratinized tissue gains can be achieved in gingival recession treatment after the application of the odontoplasty. The STROBE checklist evaluated 22 items, and all the included studies had a high-quality assessment (greater than 75%) with values greater than 85%. Then, it was not possible to draw conclusions due to the number of articles included, even though they had high-quality assessments. Otherwise, it is possible to suggest that the root prominence may impact gingival recession. Therefore, new and well-designed studies must be developed to establish a significant conclusion about this condition. Full article

Ostomy formation is a vital component in the treatment of advanced gastrointestinal diseases, including colorectal cancer and inflammatory bowel disease. It usually involves externalizing a part of the colon or small bowel to the skin surface. Thus, the creation of an ostomy can often have a major negative impact on quality of life. This study aimed to evaluate whether the use of an ostomy belt could improve quality of life measures in stoma patients through a prospective interventional open-label study of 17–80-year-old English- and Spanish-speaking patients with stomas who were using an ostomy belt for 8 weeks. Changes in quality of life were assessed using the Stoma Quality of Life Scale questionnaire at baseline, at 4 weeks, and at 8 weeks post ostomy belt use. A total of 45 patients enrolled (20 female, mean age 48) in the study. The ostomy belt significantly improved quality of life scores from baseline to 4 weeks regarding overall life satisfaction (F(2, 76) = 14.77, p < 0.001) and in the domains of work/social function (F(2, 72) = 30.32, p < 0.001), sexuality/body image (F(2, 68) = 3.34, p = 0.04), and stoma function (F(2, 72) = 8.72, p < 0.001). These improvements were sustained at the 8-week follow-up. No significant differences were observed in the domains of financial impact and skin irritation. This study represents the first prospective interventional study that provides evidence for the simple low-cost intervention of ostomy support belt use in improving quality of life in patients with a stoma. Full article

Accessory liver lobe is a rare finding, with the most common cases being accessory liver tissue on the gallbladder wall separate from the orthotopic liver. As the incidence of the ectopic liver is low there are only several case reports in published literature that describe similar presentations. We report a case of intrathoracic liver lobe that was connected to the main liver by a thick pedicle. Due to benign presentation, the patient was discharged without any surgical intervention. This case highlights the importance of understanding anatomical variability of internal organs, understanding the risks of torsion and malignant transformation of the accessory liver tissue. The literature review provides an excellent overview of published case series and reports, and outlines current recommendations on imaging, diagnosis, and management. Full article

Background: Little is known regarding how patient insurance status influences outcomes after extensor tendon-injury repair. We aim to establish a relationship between the outcomes of primarily repaired extensor tendon injuries and patient insurance status. We hypothesize that commercially insured patients will achieve superior outcomes due to more facile access to postoperative hand therapy and fewer barriers to appropriate postoperative care. Methods: A retrospective chart review was conducted of patients who underwent primary extensor tendon repair in any zone, excluding the thumb, at a single large safety-net hospital. Inclusion criteria included a minimum of eight weeks of follow-up, complete data available for review, and an extensor tendon injury requiring primary surgical repair. Four cohorts were examined: patients with commercial insurance, patients with Medicare/Medicaid, patients with county hospital-sponsored insurance, and uninsured patients. Statistical analysis was performed using Chi-Square and ANOVA analyses, with significance defined as p ≤ 0.05. Results: Of the 62 patients (100 digits) included, 20 had commercial insurance, 12 had Medicare/Medicaid, 13 had hospital-sponsored insurance, and 17 were uninsured. Except for mean age, there were no significant differences between groups in terms of demographic data, medical comorbidities, or digit characteristics. There were also no significant differences in mean follow-up, time to return to full activity, or surgical complications among groups. Procedure duration differed significantly between groups, with procedures lasting longer in uninsured patients. Postoperative final flexion total arc of motion (TAM) and extension measurements were similar across all groups. Additionally, hand therapy visits did not differ significantly between groups. Conclusions: Following extensor tendon repair, patient insurance status did not affect outcomes in terms of final range of motion, return to full activity, or postoperative complications. Full article

Injury to the Luschka ducts (LDs), also named “subvesicular” ducts, is an under-reported cause of biliary leak following laparoscopic cholecystectomy (LC). A systematic literature search according to PRISMA guidelines was conducted in PubMed, EMBASE and Cochrane Library including all publications that described a bile leak from an LD. A total of 136 articles were retrieved from the searched databases. After the removal of duplicates and non-eligible papers, 48 studies reporting 231 leaks were included: 20 (41.6%) case reports, 2 (4.3%) comparative studies, 7 (14.9%) meeting abstracts and 19 (40.4%) retrospective cohort articles. The rate of LD leak ranges from 0.05% to 1.9%, but injury to a duct of Luschka was the second most common cause of biliary leakage in all the cohort studies (5.5% to 41%). In 21 (43.7%) cases, the leak was successfully treated with a sphincterotomy through Endoscopic Retrograde Cholangiopancreatography (ERCP) plus or minus stenting, and in 12 (25%), re-laparoscopy was necessary. Full article

Growth of malignant cells in solid tumors induces changes to the tumor microenvironment (TME). These changes result in promotion of tumor growth, invasion, and metastasis, but also in tumor resistance to drugs and radiotherapy. The enhanced permeability and retention (EPR) effect in neo-angiogenic tumor tissue enables the transport of therapeutic molecules from the circulation into the tumor, but studies show that further diffusion of these agents is often not sufficient for efficient tumor eradication. Despite the hyperpermeable vasculature facilitating the delivery of drugs and tracers, the high density of stromal cells and matrix proteins, in combination with the elevated interstitial fluid pressure in the microenvironment of solid tumors, presents a barrier which limits the delivery of compounds to the core of the tumor. Reversing the cancer-cell-induced changes to the microenvironment as well as novel nanoparticle strategies to circumvent tumor-induced stromal changes have therefore been suggested as potential methods to improve the delivery of therapeutic molecules and drug efficacy. Strategies to modulate the TME, i.e., normalization of tumor vasculature and depletion of excessive stromal proteins and cells, show promising results in enhancing delivery of therapeutic compounds. Modulation of the TME may therefore enhance the efficacy of current cancer treatments and facilitate the development of novel treatment methods as an alternative for invasive resection procedures. Full article

Online artificial intelligence (AI) tools have recently gained in popularity. So-called “generative AI” chatbots unlock new opportunities to access vast realms of knowledge when being prompted by users. Here, we test the capabilities of two such AIs in order to determine the benefits for plastic surgery while also assessing the potential risks. Future developments are outlined. We used the online portals of OpenAI’s ChatGPT (version 3.5) and Google’s Bard to ask a set of questions and give specific commands. The results provided by the two tools were compared and analyzed by a committee. For professional plastic surgeons, we found that ChatGPT and Bard can be of help when it comes to conducting scientific reviews and helping with scientific writing but are of limited use due to the superficiality of their answers in specific domains. For medical students, in addition to the above, they provide useful educational material with respect to surgical methods and exam preparation. For patients, they can help when it comes to preparing for an intervention, weighing the risks and benefits, while providing guidance on optimal post-operative care. ChatGPT and Bard open widely accessible data to every internet user. While they might create a sense of “magic” due to their chatbot interfaces, they nonetheless can help to increase productivity. For professional surgeons, they produce superficial answers—for now—albeit providing help with scientific writing and literature reviews. For medical students, they are great tools to deepen their knowledge about specific topics such as surgical methods and exam preparation. For patients, they can help in translating complicated medical jargon into understandable lingo and provide support for pre-operative as well as post-operative care. Such AI tools should be used cautiously, as their answers are not always precise or accurate, and should always be used in combination with expert medical guidance. Full article

Artificial intelligence (AI) is a promising tool for diagnosing rib fractures. To date, only a few studies have quantified its performance. The objective of this systematic review was to assess the accuracy of AI as an independent tool for rib fracture detection on CT scans or radiographs. This was defined as the combination of sensitivity and specificity. PubMed (including MEDLINE and PubMed Central) was systematically reviewed according to the PRISMA statement followed by citation searching among studies up to December 2022. Methods of the analysis and inclusion criteria were prespecified in a protocol and published on PROSPERO (CRD42023479590). Only diagnostic studies of independent AI tools for rib fracture detection on CT scans and X-rays reporting on sensitivity and/or specificity and written in English were included. Twelve studies met these criteria, which included 11,510 rib fractures in total. A quality assessment was performed using an altered version of QUADAS-2. Random-effects meta-analyses were performed on the included data. If specificity was not reported, it was calculated on a set of assumptions. Pooled sensitivity and specificity were 0.85 (95% CI, 0.78–0.92) and 0.96 (95% CI, 0.94–0.97), respectively. None of the included studies used X-rays. Thus, it can be concluded that AI is accurate in detecting rib fractures on CT scans. Overall, these findings seemed quite robust, as can be concluded from the study quality assessment, therefore AI could potentially play a substantial role in the future of radiological diagnostics. Full article

The supratrochlear artery (STA) demonstrates anatomical variability that impacts facial reconstruction with a paramedian forehead flap. STA branching patterns and the distance to the midline have been reported, but the STA pedicle has not been characterized. Our aim was to triangulate the STA pedicle relative to known anatomical landmarks and identify a danger zone to aid surgeons in creating viable tissue flaps. The upper facial region was dissected bilaterally on 38 cadaveric donors. Measurements from the supraorbital neurovascular bundle, orbital rim, and medial canthus to the STA pedicle were collected. Data were tallied and statistically analyzed. Measurement means, range, and standard deviations were calculated; no significant differences were found in the laterality of the measurements (p > 0.05). Statistically significant, sex-based differences were identified for all measurements collected among male and female donors. This study characterizes a surgical danger zone for the STA pedicle specific to a paramedian forehead flap and identifies important differences within this danger zone among male versus female donors that surgeons should consider to prevent pedicle violation and enhance surgical success while maximizing flap length and mobility. Full article

Embryological development of the vascular system consists of growth and regression of developing vessels, often resulting in numerous variations. This cadaveric case report describes an individual with a duplicated inferior vena cava accompanied by multiple left accessory renal veins and a superior mesenteric artery-derived left colic artery. These structures may present clinical concerns when physicians are unaware of their presence during even routine surgeries. The 74-year-old female donor was dissected as part of a medical gross anatomy elective course. Anatomy was photographed and measurements were taken. Dissection revealed a duplicated inferior vena cava with a confluence between the right and left inferior venae cavae, known as the preaortic trunk. The left gonadal vein drained directly into the left inferior vena cava, inferior to the vena cava’s junction with the left renal vein. The multiple accessory left renal veins drained into the left inferior vena cava at the level of the primary left renal vein. All three anomalies examined in this donor have the potential to create complications during surgery. Promoting familiarity amongst physicians, particularly radiologists and surgeons, with vascular anomalies can aid in their ability to assess patients and provide better care. Full article