Surgery Commons^™

2024 Canadian Surgery Forum: Sept. 25-28, 2024., Christine Li, Michael Guo, Ahmer Karimuddin, Michael Guo, Christine Li, Ahmer Karimuddin, Jason Sutherland, Bright Huo, Tyler Mckechnie, Monica Ortenzi, Yung Lee, Stavros Antoniou, Julio Mayol, Hassaan Ahmed, Vanessa Boudreau, Karim Ramji, Cagla Eskicioglu, Pieter De Jager, David Urbach, Meredith Poole, Aghiles Abbad, Hussain Al-Shamali, Zainab Al-Faraj, Chuck Wen, Radu Pescarus, Robert Bechara, Dennis Hong, Lily J Park, Maura Marcucci, Sandra Ofori, Jessica Bogach, Pablo E Serrano, Marko Simunovic, Ilun Yang, Margherita Cadeddu, Michael J Marcaccio, Flavia K Borges, Rahima Nenshi, P J Devereaux, Peter Urbanellis, Joanne Douglas, Evan Nemeth, James Ellsmere, Richard Spence, Joshua Cunningham, Ryan Falk, Tom Skinner, Nicole Ebert, Lauren Galbraith, Mark Prins, Shahrzad Joharifard, Emilie Joos, Adele Orovec, Lynn Lethbridge, Richard Spence, Marius Hoogerboord, Heather Stuart, Anne-Marie Bergeron, Ilun Yang, Jessica Bogach, Laura Nguyen, Clare Reade, Lua Eiriksson, Michelle Morais, Gillian Hanley, Sarah Mah, Karanbir Brar, Keri A Seymour, Shaina R Eckhouse, Ranjan Sudan, Jacob A Greenberg, Dana Portenier, James J Jung, Anne Light, Brittany Dingley, Megan Delisle, Sameer Apte, Ranjeeta Mallick, Trevor Hamilton, Heather Stuart, Martha Talbot, Gregory Mckinnon, Evan Jost, Eve Thiboutot, Carolyn Nessim, Neha Katote, Ashley Drohan, Richard Spence, Katerina Neumann, Ge Shi, Regina Leung, Christina Lim, Matthew Van Oirschot, Aaron Grant, Sarah Knowles, Julie Ann Van Koughnett, Karine Brousseau, Leah Monette, Daniel Mcisaac, Christopher Wherrett, Ranjeeta Mallick, Aklile Workneh, Tim Ramsay, Alan Tinmouth, Julie Shaw, François Martin Carrier, Dean Fergusson, Guillaume Martel, Matthew Cornacchia, Victoria Ivankovic, Shahad Abdulkhaleq Mamalchi, Dexter Choi, Peter Glen, Maher Matar, Fady Balaa, Natasha Caminsky, Sarah Mashal, Nathalie Boulanger, Larry Watt, Jonathon Campbell, Jeremy Grushka, Paola Fata, Evan Wong, Michael Guo, Ahmer Karimuddin, Jason Sutherland, Christine Li, Wenjie Lin, Ahmer Karimuddin, Bright Huo, Elisa Calabrese, Sunjay Kumar, Bethany Slater, Danielle S Walsh, Wesley Vosburg, Uzair Jogiat, Simon Turner, Vickie Baracos, Dean Eurich, Heather Filafilo, Eric Bedard, Sam Khan, Tom Waddell, Kazuhiro Yasufuku, Andrew Pierre, Shaf Keshavjee, Elliot Wakeam, Laura Donahoe, Marcelo Cypel, Najib Safieddine, Michael Ko, Natasha Leighl, Jamie Feng, Jonathan Yeung, Marc De Perrot, Alexandra Salvarrey, Negar Ahmadi, Carmine Simone, Gazala Sayf, David Parente, Victoria Cheung, Mary R Rabey, Michael Cabanero, Lisa W Le, Christodoulos Pipinikas, Amber Chevalier, Richard Chaulk, David Sahai, Richard Malthaner, Mehdi Qiabi, Dalilah Fortin, Richard Inculet, Rahul Nayak, John Campbell, Peter White, Adam Bograd, Alexander Farivar, Brian Louie, Geraint Berger, Daniel French, Simon Houston, Flyn Gallardo, Bryce Macek, Richard Liu, Biniam Kidane, Nader M Hanna, Yogita S Patel, Ikennah Browne, Esther Provost, Forough Farrokhyar, Ehsan Haider, Waël C Hanna, Garrett Johnson, George Okoli, Nicole Askin, Ahmed Abou-Setta, Harminder Singh, Alexandra Coxon-Meggy, Julie Cornish, Lars Icat Study Management Group, Sahil Sharma, Jigish Khamar, Jo-Anne Petropolous, Amandeep Ghuman, Wenjie Lin, Christine Li, Carl Brown, Terry Phang, Manoj Raval, Amandeep Ghuman, Elizabeth Clement, Ahmer Karimuddin, Tyler Mckechnie, Jigish Khamar, Christopher Chu, Amin Hatamnejad, Ghazal Jessani, Yung Lee, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Giancarlo Sticca, Madeleine Poirier, Jean-François Tremblay, Jean-François Latulippe, Yves Bendavid, Jean-Sébastien Trépanier, Ariane Lacaille-Ranger, Margaret Henri, Tyler Mckechnie, Tania Kazi, Victoria Shi, Shan Grewal, Ahmed Aldarraji, Kelly Brennan, Sunil Patel, Nalin Amin, Aristithes Doumouras, Sameer Parpia, Cagla Eskicioglu, Mohit Bhandari, Gaurav Talwar, Tyler Mckechnie, Jigish Khamar, Luke Heimann, Swati Anant, Cagla Eskicioglu, Victoria Shi, Tyler Mckechnie, Swati Anant, Moeiz Ahmed, Sahil Sharma, Gaurav Talwar, Dennis Hong, Cagla Eskicioglu, Tania Kazi, Tyler Mckechnie, Yung Lee, Rehab Alsayari, Gaurav Talwar, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Lily J Park, Husein Moloo, Tim Ramsay, Kednapa Thavorn, Justin Presseau, Terry Zwiep, Guillaume Martel, P J Devereaux, Robert Talarico, Daniel I Mcisaac, Madeline Lemke, Wenjie Lin, Carl Brown, Elizabeth Clement, Anu Ghuman, Terry Phang, Manoj Raval, Ahmer Karimuddin, Christine Li, Wenjie Lin, Elizabeth Clement, Amandeep Ghuman, Cameron Hague, Ahmer Karimuddin, P Terry Phang, Manoj Raval, Pari Tiwari, Patrick Vos, Carl Brown, Alessandro Ricci, Ameer Farooq, Sunil Patel, Kelly Brennan, Vanessa Wiseman, Tyler Mckechnie, Allison Keeping, Paul Johnson, Heidi Bentley, Karim Messak, Jessica Bogach, Gregory Pond, Shawn Forbes, Vanja Grubac, Scott Tsai, Christian Van Der Pol, Marko Simunovic, Adom Bondzi-Simpson, Ramy Behman, Tiago Ribeiro, Sheron Perera, Aisha Lofters, Rinku Sutradhar, Rebecca Snyder, Callisia Clarke, Natalie Coburn, Julie Hallet, Natasha Caminsky, Alex Chen, Jeongyoon Moon, Paul Brassard, Daniel Marinescu, Teodora Dumitra, Ebram Salama, Carol-Ann Vasilevsky, Marylise Boutros, Kelly Brennan, Tyler Mckechnie, Vanessa Wiseman, Alessandro Ricci, Ameer Farooq, Sunil Patel, Tania Kazi, Tyler Mckechnie, Ghazal Jessani, Victoria Shi, Niv Sne, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Manisha Jogendran, Jennifer Flemming, Maya Djerboua, Martin Korzeniowski, Brooke Wilson, Shaila Merchant, Sean Bennett, Kala Hickey, Stephanie Gill, Zoë Breen, Kaitlyn Harding, Hannah Yaremko, Patti Power, Alex Mathieson, David Pace, Joannie Neveu, Sean Bennett, Brooke Wilson, Nan Chen, Weidong Kong, Sunil Patel, Christopher Booth, Shaila Merchant, Sean Bennett, Georgia Nelson, Nouf Almarzooqi, Manisha Jogendran, Maya Djerboua, Brooke Wilson, Jennifer Flemming, Shaila Merchant, Lily J Park, Carol Wang, Vicki Archer, Tyler Mckechnie, Dan Cohen, Jessica Bogach, Marko Simunovic, Pablo E Serrano, Rodney H Breau, Paul Karanicolas, P J Devereaux, Georgia Nelson, Nouf Almarzooqi, Shaila Merchant, Sean Bennett, Janyssa Charbonneau, Mai-Kim Gervais, Alexandre Brind'amour, Narcisse Singbo, Mikaël Lefebvre Soucisse, Lucas Sidéris, Guy Leblanc, Jean-François Tremblay, Pierre Dubé, Ekaterina Kouzmina, Matthew Castelo, Nicole Look Hong, Julie Hallet, Natalie Coburn, Frances Write, Lena Nguyen, Sonal Gandhi, Katarzyna Jerzak, Andrea Eisen, Amanda Roberts, Dejan Vidovic, Brianne Cruickshank, Lucy Helyer, Carman Giacomantonio, Zuhaib Mir, Matheus Faleiro, Stephanie Hiebert, Scott Livingstone, Mark Walsh, Boris Gala-Lopez, Sukhdeep Jatana, Daniel Krys, Uzair Jogiat, Janice Kung, Kevin Verhoeff, Tori Lenet, François Martin Carrier, Karine Brousseau, Franck Vandenbroucke-Menu, Yves Collin, Richard W D Gilbert, Maja Segedi, Jad Abou Khalil, Kimberly A Bertens, Fady Balaa, Dean A Fergusson, Guillaume Martel, Christopher Wherrett, Katlin Mallette, Leah Monette, Aklile Workneh, Monique Ruel, Elham Sabri, Heather Maddison, Melanie Tokessym, Patrick B Y Wong, Luc Massicotte, Michaël Chassé, Michel-Antoine Perrault, Élodie Hamel-Perreault, Jeieung Park, Shirley Lim, Véronique Maltais, Philemon Leung, Timothy Ramsay, Alan Tinmouth, Zofia Czarnecka, Nidheesh Dadheeech, Rena Pawlick, Haide Razavy, James Shapiro, Panthea Pouramin, Susan Allen, Boris Gala-Lopez, Nawal Amhis, Rachel Liu Hennessey, Yuwei Yang, Rochelle Guan, Yolanda Zhang, Adam Meneghetti, Chieh Chiu, Dhuvaraha Srikrishnaraj, Jeffrey Hawel, Christopher Schlachta, Ahmad Elnahas, Ayse Yilbas, Marguerite Mainprize, Anton Svendrovski, Christoph Paasch, Fernando Spencer Netto, Jigish Khamar, Tyler Mckechnie, Amin Hatamnejad, Yung Lee, Bright Huo, Edward Passos, Niv Sne, Cagla Eskicioglu, Dennis Hong, Sean Bennett, Jennifer Flemming, Maya Djerboua, Vanessa Wiseman, Jonah Moore, Peter Szasz, Sulaiman Nanji, Jonah Moore, Vanessa Wiseman, Peter Szasz, Isis Lunsky, Sulaiman Nanji, Jennifer A Flemming, Sean Bennett, Sandra Mckeown, Omar Mouhammed, Colton Gibb, Kevin Verhoeff, Michael Kim, Matt Strickland, Ram Anantha, Ilinca Georgescu, Yung Lee, Thomas Shin, Lea Tessier, Arshia Javidan, James Jung, Dennis Hong, Tyler Mckechnie, Andrew Strong, Matthew Kroh, Jerry Dang, Muhammad Faran, Tyler Mckechnie, Emma O'Callaghan, Sama Anvari, Taylor Hughes, Mark Crowther, Mehran Anvari, Aristithes Doumouras, Amin Andalib, Ali Safar, Philippe Bouchard, Sebastian Demyttenaere, Olivier Court, Simran Parmar, Brianna Brand, Noah Switzer, Richdeep Gil, Sunawer Aujla, Morgan Schellenberg, Natthida Owattanapanich, Brent Emigh, Jan-Michael Van Gent, Tanya Egodage, Patrick B Murphy, Chad Ball, Audrey L Spencer, Kelly N Vogt, Jessica A Keeley, Stephanie Doris, Kenji Inaba, Jordan Nantais, Nancy Baxter, Refik Saskin, Andrew Calzavara, David Gomez, Alex Le, Philip Dawe, Morad Hameed, Amir Hassanpour, Eran Shlomovitz, David Gomez, Eisar Al-Sukhni, Vanessa Wiseman, Sunil Patel, Sean Bennett, Zuhaib Mir, Stephanie Roberts, Harvey Hawes, Khalil Merali, Rachel Morris, Marc De Moya, Todd Neideen, Andrew Kastenmeier, Lewis Somberg, Dan Holena, Patrick Murphy, Jordan Nantais, Nancy Baxter, Refik Saskin, Andrew Calzavara, David Gomez, Asad Naveed, Umang Deshpande, David Gomez, Joao Rezende-Neto, Najma Ahmed, Andrew Beckett

Surgery Articles

No abstract provided.

Inflammation And Fibrosis In Orbital Inflammatory Disease: A Histopathologic Analysis., Rohan Verma, Allison J Chen, Dongseok Choi, David J Wilson, Hans E Grossniklaus, Roger A Dailey, John D Ng, Eric A Steele, Stephen R Planck, Craig N Czyz, Bobby S Korn, Don O Kikkawa, Jill A Foster, Michael Kazim, Gerald J Harris, Deepak P Edward, Azza Al Maktabi, James T Rosenbaum

Surgery Articles

PURPOSE: The purpose of this study was to compare the histopathologic inflammation and fibrosis of orbital adipose tissue in orbital inflammatory disease (OID) specimens.

METHODS: In this retrospective cohort study, inflammation, and fibrosis in orbital adipose tissue from patients with thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis, nonspecific orbital inflammation (NSOI), and healthy controls were scored by 2 masked ocular pathologists. Both categories were scored on a scale of 0 to 3 with scoring criteria based on the percentage of specimens containing inflammation or fibrosis, respectively. Tissue specimens were collected from oculoplastic surgeons at 8 international centers representing 4 …

Operative Technique For A Successful Laparoscopic En-Bloc Resection Of Gastrogastric Fistula Following Roux-En-Y Gastric Bypass., Krishna Patel, Jordyn Perdue, Jaya Varre, Vinnie Serapiglia, Anthony Rizzo, Thomas Sonnanstine

Surgery Articles

Gastrogastric fistulas are rare complications following Roux-en-Y gastric bypass surgery and are characterized by a fistulous connection between the gastric pouch and the remnant stomach. The presentation is often variable and a high-index of suspicion must be maintained for accurate and timely diagnosis. In this case report, we provide a detailed review of the technical steps taken to successfully resect a gastrogastric fistula en-bloc laparoscopically with an unremarkable post-operative course.

Mild Biceps Tendonitis May Be Managed Nonoperatively During Shoulder Arthroscopy., Jonathan J Light, Wihan Du Plessis, Matthew H Adsit, Alexander T Eckstrom, Amanda B Firoved, Justin W Griffin, Kevin F Bonner

Surgery Articles

PURPOSE: The purposes of this study were to determine whether patients with mild biceps tendonitis required revision surgery after the biceps tendon was not surgically treated, while addressing concomitant pathology, and to evaluate whether preoperative groove pain affected patient-reported outcomes.

METHODS: Patients who underwent shoulder arthroscopy between 2015 and 2018 by a single surgeon for rotator cuff pathology, debridement, and distal clavicular excision (DCE), with or without subacromial decompression (SAD), and where the biceps tendon was not surgically addressed were retrospectively identified. Inclusion criteria were mild LS (< 50% hyperemic appearing biceps tendon arthroscopically), and a minimum 2-year follow-up. The primary outcome measure was the incidence of revision surgery. Secondary outcomes included American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), pain level, and satisfaction scores. Two sample

RESULTS: Sixty-four of 69 eligible subjects (93%) were evaluated at a minimum …

A Paradoxical Internal Hernia At Brolin's Anti-Obstruction Stitch Following Roux-En-Y Gastric Bypass: A Case Report., Krishna Patel, Vinnie Serapiglia, Anthony N Rizzo, Jaya Varre, Thomas Sonnanstine

Surgery Articles

Internal hernias are a rare but morbid complication following Roux-en-Y gastric bypass surgery. The incorporation of Brolin's anti-obstruction stitch has historically demonstrated a significant reduction in the incidence of internal hernias following Roux-en-Y gastric bypass. We present an ironic and unique case of a patient with small bowel herniation into a defect between Brolin's stitch and the stapled closed common enterotomy of the jejunojejunostomy and technical considerations to decrease internal hernias at this site in the future.

Surgical Management Of Congenital Malrotation Presenting In Adulthood., Jacob Holzemer, Krishna Patel, Oscar Ruiz, Jodi Oostra

Surgery Articles

Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial …

Two Thymomas Of Different Histological Subtypes Arising In A Giant Thymolipoma: Case Report And Review Of The Literature., Vincent C Daniel, Konstantin Shilo

Surgery Articles

Thymolipoma is a rare benign tumor of the anterior mediastinum. Only a few reports describing thymoma arising within a thymolipoma have been documented in the literature. We report herein a detailed description of thymolipoma giving rise to 2 thymomas of different histological subtypes. A 74-year-old male with history of metastatic papillary thyroid carcinoma gradually developed 2 soft tissue nodules within a large right hemithorax fatty mass that was present for the past 20 years. Computed tomography (CT)-guided needle biopsy revealed one of the soft tissue nodules to be a thymoma, and the entire mass was surgically resected. Final pathological examination …

A Case Report Of Acute Appendicitis Complicated By Pylephlebitis: Medical And Surgical Management., Krishna Patel, Jaya Sai Varre, Nate Williams, Oscar Ruiz

Surgery Articles

Pylephlebitis is a suppurative thrombus of the portal vein and/or its branches secondary to an intra-abdominal infection. Acute appendicitis is the most common cause of emergency operation in general surgery and is typically treated with antibiotics and timely appendectomy with minimal adverse outcomes (Ferris M, Quan S, Kaplan BS, et al. The global incidence of appendicitis: a systematic review of population-based studies.

View-Vlu Observational Study Of The Effect Of Varithena On Wound Healing In The Treatment Of Venous Leg Ulcers., Michael Y Shao, Stuart Harlin, Beverly Chan, Kathylee Santangelo, Eri Fukaya, Julianne Stoughton, Raghu Kolluri

Heart and Vascular Articles

OBJECTIVE: Chronic venous hypertension, triggered by venous reflux and/or obstruction, leads to skin changes and venous leg ulcers (VLUs). Compression therapy is the standard of care, but many wounds remain unhealed. The objectives of this study were to observe the effects of endovenous chemical ablation with commercially available 1% polidocanol injectable microfoam on VLU healing and recurrence rates.

METHODS: The VIEW VLU study was a multicenter, open-label, phase IV registry of patients with active VLUs resulting from venous insufficiency of the great saphenous vein and/or anterior accessory saphenous vein systems who underwent ablation with 1% polidocanol microfoam. Primary outcomes included …

Primary Retrograde Tibiotalocalcaneal Nailing In An Elderly Osteoporotic Patient With Ankle Fracture: A Case Report., Nolan P Schmitz, Daniel R Gaines, Jignesh N Patel

Surgery Articles

INTRODUCTION: Ankle fractures are a common orthopedic injury traditionally treated with open reduction and internal fixation or conservative management. One complication introduced with open reduction and internal fixation is the requirement for non or partial weight bearing in the post-operative period. This requirement poses a unique challenge for patients who may not comply with these weight-bearing restrictions. This case is the first known article that specifically illustrates the validity and effectiveness of retrograde tibiotalocalcaneal (TTC) nailing for patients who are unlikely to follow weight-bearing restrictions.

CASE REPORT: An 83-year-old Caucasian female with idiopathic mild mental retardation and Alzheimer's presented with …

Incidence And Predictors Of Acute Limb Ischemia In Acute Myocardial Infarction Complicated By Cardiogenic Shock., Carlos M Romero, Irfan Shafi, Aadhar Patil, Eric Secemsky, Ido Weinburg, Raghu Kolluri, Huaqing Zhao, Vladimir Lakther, Riyaz Bashir

Heart and Vascular Articles

OBJECTIVE: To describe the incidence and predictors of acute limb ischemia (ALI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).

METHODS: Patients with index hospitalizations for AMI complicated by cardiogenic shock from 2016 to 2019 in the US National Readmission Database were identified. We evaluated the incidence of ALI and its associated mortality, length of stay, and cost of hospitalization. We used multivariable logistic regression to determine independent predictors of ALI in this population.

RESULTS: A total of 84,615 patients had AMI complicated by cardiogenic shock and 1302 (1.54%) developed ALI. The rates of ALI increased …

Peri-Implant Proximal Humerus Fracture Stabilized With Stacked Plating: A Case Report., Daniel T Degenova, Matthew T Glazier, John B Schrock, Brian W Skura, Taylor N Hockman, Benjamin C Taylor

Surgery Articles

INTRODUCTION: A peri-implant proximal humerus fracture is a rare complication after open reduction and internal fixation (ORIF) and poses a surgical dilemma.

CASE REPORT: A 56-year-old male sustained a peri-implant proximal humerus fracture after undergoing ORIF. We present a stacked plating method for fixation of this injury. This construct allows for decreased operative time, less soft-tissue dissection, and the ability to leave previous intact hardware in place.

CONCLUSION: We describe the rare case of a peri-implant proximal humerus treated with stacked plating.

Differences Between Patients With Diabetes Mellitus And Those Without In Cases Of Necrotizing Fasciitis., Daniel T Degenova, Scott S Hyland, Tucker Peabody, Nolan P Schmitz, Devon Myers, Robert Patterson, Jignesh Patel

Surgery Articles

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk …

A Symptomatic Cystic Axillary Mass In A Post-Partum Female., Nicole Werwie, Jodi Oostra, Kelly Hanley

Surgery Articles

Hemangiomas are rarely found in the axilla, with the most commonly identified axillary mass being lymphadenopathy. We report a unique case report of a post-partum female with an axillary mass that became larger and symptomatic while breastfeeding. On imaging, the mass was found to be complex and cystic, and aspiration was attempted several times. With a rapid return of swelling and worsening symptoms, there was concern for bleeding into the cystic cavity. Ultimately, the >10 cm mass had to be formally excised in the operating room, yielding definitive relief of symptoms. Final pathology reported the mass as a vascular malformation, …

Multiseptate Gallbladder Presenting With Biliary Colic., Peter Hopmann, Ellen Tan, David Lo

Surgery Articles

Common diagnoses associated with right upper quadrant and epigastric pain include cholecystitis, peptic ulcer disease (PUD), biliary colic, gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). Multiseptate gallbladder is a rare congenital anomaly that can cause symptoms of biliary colic, however it may present with atypical symptoms, which can prolong definitive diagnosis and treatment. We present a case of multiseptate gallbladder in a 21-year-old female who initially presented with GERD and IBS. After multiple failed treatment regimens for IBS, she ultimately was found to have multiseptate gallbladder and was successfully treated with cholecystectomy.

Tracheal Necrosis Following Two-Stage Thyroidectomy: A Case Report., Taylor Colvin, Chris Selinsky

Surgery Articles

Tracheal necrosis is a rare complication of a thyroidectomy, almost exclusively following the resection of invasive thyroid carcinoma with tracheal involvement. We report a case of delayed tracheal necrosis following a routine thyroidectomy for noninvasive papillary thyroid carcinoma likely secondary to a postoperative seroma. This complication was successfully managed with a temporary tracheostomy.

Outcomes From A Tertiary Care Center Using A Catheter Thrombectomy System For Managing Acute Iliofemoral Deep Vein Thrombosis., Michael A Jolly, Marie M Lockhart, Deep Shah, Christopher M Huff, Elizabeth A Valenti, John A Phillips, Samih Bittar, Charles F Botti, Raghu Kolluri, Mitchell J Silver

OhioHealth Research Institute Articles

OBJECTIVE: The aim of the present study was to report a large, single-center experience using the ClotTriever thrombectomy system (Inari Medical, Irvine, CA) for the management of acute iliofemoral (IF) deep vein thrombosis (DVT). One limitation of all endovascular devices for the treatment of acute IF-DVT has been the inability to completely remove all acute thrombus and the need for adjunctive thrombolysis with its attendant risk of bleeding complications.

METHODS: A single-center retrospective review of consecutive patients with acute IF-DVT treated with the ClotTriever thrombectomy system (Inari Medical) is reported. Procedural efficacy was evaluated by an independent core imaging laboratory …

Artelon As A Bio-Scaffold To Augment Collateral Ligament Repair After Knee Dislocation., D M Myers, S Hyland, A Paulini, A Melaragno, B J Passias, B C Taylor

Surgery Articles

INTRODUCTION: Knee dislocations (KD) have high rates of multi-ligamentous injury (MLI). Collateral ligaments rupture in 50-60% of KDs. Traditionally, collateral ligaments have undergone primary repair, though microscopic healing is not optimal. Artelon is a degradable, polyurethane urea bio-scaffold thought to decrease mechanical forces and promote healing, motion, and strength. Currently, little evidence exists regarding its indications or outcomes.

MATERIAL AND METHODS: Thirty-two patients with KD and MLI undergoing collateral ligament repair at a level-I trauma centre between 2015-2020 were included. Patients age < 18, with ipsilateral fractures or inadequate follow-up were excluded. The Artelon (AG) and primary ligamentous repair group (PR) each included 16 patients. Injury and perioperative variables were evaluated using SPSS® .

RESULTS: Thirty-two KDs were included in 32 patients, with 60% anterior. There were no significant differences between the …

Resolution Of Deep Peroneal Nerve Palsy After Seroma Evacuation In A Primary Total Hip Arthroplasty: A Case Report., Brian W Skura, Craig Goubeaux, William C Burgette

Surgery Articles

INTRODUCTION: In this manuscript, we present a late presentation of deep peroneal nerve symptoms after total hip arthroplasty (THA) which subsequently completely resolved after seroma evacuation and sciatic nerve decompression. While hematoma formation causing deep peroneal nerve symptoms after THA has been reported in the literature, we are unaware of any reports of seroma formation causing similar symptoms.

CASE PRESENTATION: A 38-year-old female underwent an uncomplicated primary THA and developed paresthesia's over the lateral leg and foot drop on post-operative day 7. Ultrasound diagnosed a fluid collection compressing the sciatic nerve. The patient underwent seroma evacuation and sciatic nerve decompression. …

The Corkscrew Technique For Removing A Fibular Strut Allograft From The Proximal Humerus., Brian Skura, Matthew T Glazier, Hayden B Schuette, Braden J Passias, Iou-Ren Chang, John Verre, Sanjay Mehta, Benjamin C Taylor

Surgery Articles

A fibular strut allograft is a reliable option for augmentation in open reduction internal fixation (ORIF) of proximal humerus fractures, but techniques to remove a fibular strut during revision shoulder arthroplasty are limited. Currently published techniques on extracting fibular strut grafts from humeral shafts include using a Midas burr, flexible osteotomes, humeral shaft osteotomy, and reaming. To our knowledge there has not been a technique that uses a corkscrew to remove the fibular strut from the proximal humerus in preparation for revision shoulder arthroplasty. This is a case report and description of a simple and reproducible technique that can be …

A Novel Simulation-Based Multidisciplinary Verbal De-Escalation Training., Gary Duncan, Megan Schabbing, Brad D Gable

Trauma and Acute Care Articles

Background Agitated or aggressive patients pose a high risk of emotional and physical harm to hospital staff. Healthcare associates have the highest rate of workplace violence among studied fields. Learning to effectively de-escalate a patient who is a danger to self or others is key to reducing these incidents. This course was designed to improve education and communication among staff on a hospital surgical floor when verbal de-escalation is needed. Methods A ninety-minute simulation-based multidisciplinary curriculum was developed. This included a 30-minute didactic discussion, 10-minute simulation, and 50-minute debrief. Learners included nurses, patient service associates, and protective services officers from …

Surgical Stabilization Of Rib Fractures In Symptomatic Covid-19: A Case Report., Jin Wu, Nirvana Saraswat, Kevin Harris, Brent Goslin, William Devoe

Surgery Articles

Severe chest wall injury following trauma is a significant contributing factor to respiratory failure and need for mechanical ventilation in multiply injured patients. Surgical stabilization of rib fractures (SSRF) is increasingly considered to be advantageous in this population. Surgical stabilization has been shown to improve multiple outcomes including ventilator avoidance, liberation from mechanical ventilation, and diminished pulmonary complications in the trauma population, particularly when performed early. During the coronavirus disease 2019 (COVID-19) pandemic, ventilators have become a scarce resource, and conservative strategies have become a critical component of intensive care. We present a report of the perioperative outcome of SSRF …

Expandable Intravertebral Implants: A Narrative Review On The Concept, Biomechanics, And Outcomes In Traumatology., Diogo L Moura, Josue P Gabriel

Surgery Articles

Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed …

Isolated Volar Dislocation Of The Distal Radioulnar Joint Treated With Successful Closed Reduction., Matthew T Glazier, Hayden B Schuette, Benjamin A Schnee, Brian Skura, Craig Goubeaux

Surgery Articles

We report the case of A 34-year-old right-hand-dominant male who presented with an isolated left volar dislocation of the distal radioulnar joint (DRUJ) without any associated fractures. The patient had sustained the injury in an altercation in the evening prior to the presentation and had woken up the next morning with left wrist pain and restricted wrist motion. Closed reduction was successful under conscious sedation and the patient was treated conservatively with splint immobilization without needing operative intervention. This report highlights a rare injury pattern - an isolated volar DRUJ dislocation - that was successfully closed reduced, despite reports that …

Response To "Letter Regarding: Cost Of Headless Vs Headed Screw Fixation For Calcaneal Osteotomy And Subtalar Arthrodesis"., Boren Morgan, Brian Steginsky, Mallory Suhling, Anand Vora

Surgery Articles

Morgan B, Steginsky B, Suhling M, Vora A. Response to "Letter Regarding: Cost of Headless vs Headed Screw Fixation for Calcaneal Osteotomy and Subtalar Arthrodesis". Foot Ankle Orthop. 2021 Apr 30;6(2):24730114211005770. doi: 10.1177/24730114211005770. PMID: 35097444; PMCID: PMC8702681.

Perioperative Pain Management And Opioid Stewardship: A Practical Guide., Sara J Hyland, Kara K Brockhaus, William R Vincent, Nicole Z Spence, Michelle M Lucki, Michael J Howkins, Robert K Cleary

Surgery Articles

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" …

A Model For Evaluating The Biomechanics Of Rib Fracture Fixation., Devon M Myers, Sean P Mcgowan, Benjamin C Taylor, B Dale Sharpe, Kyle J Icke, Anup Gandhi

Surgery Articles

INTRODUCTION: High rates of morbidity and mortality following flail chest rib fractures are well publicized. Standard of care has been supportive mechanical ventilation, but serious complications have been reported. Internal rib fixation has shown improvements in pulmonary function, clinical outcomes, and decreased mortality. The goal of this study was to provide a model defining the biomechanical benefits of internal rib fixation.

METHODS: One human cadaver was prepared with an actuator providing anteroposterior forces to the thorax and rib motion sensors to define interfragmentary motion. Cadaveric model was validated using a prior study which defined costovertebral motion to create a protocol …

The Effect Of Obesity On Operative Time And Postoperative Complications For Peritrochanteric Femur Fractures., Hayden B Schuette, William M Durkin, Braden J Passias, Daniel Degenova, Carina Bertolini, Philip Myers, Benjamin C Taylor

Surgery Articles

Introduction The high prevalence of obesity among adults in the United States presents significant challenges to orthopedic surgeons. Obesity has been shown to increase operative time and complications in both elective and nonelective orthopedic surgeries. Despite this, there is a lack of literature evaluating the effect obesity has on operative time and postoperative complications following peritrochanteric fracture surgery. Methods and Materials We performed a retrospective review of patients who underwent isolated operative stabilization of a peritrochanteric femur fracture at our urban level one trauma center between 2010 and 2018. Patients were divided into an obese group, as defined by a …

Does Race Impact Functional Outcomes In Patients Undergoing Robotic Partial Nephrectomy?, Ugo G Falagario, Alberto Martini, John Pfail, Patrick-Julien Treacy, Kennedy E Okhawere, Bheesham D Dayal, John P Sfakianos, Ronney Abaza, Daniel D Eun, Akshay Bhandari, James R Porter, Ashok K Hemal, Ketan K Badani

Surgery Articles

BACKGROUND: The role of race on functional outcomes after robotic partial nephrectomy (RPN) is still a matter of debate. We aimed to evaluate the clinical and pathologic characteristics of African American (AA) and Caucasian patients who underwent RPN and analyzed the association between race and functional outcomes.

METHODS: Data was obtained from a multi-institutional database of patients who underwent RPN in 6 institutions in the USA. We identified 999 patients with complete clinical data. Sixty-three patients (6.3%) were AA, and each patient was matched (1:3) to Caucasian patients by age at surgery, gender, Charlson Comorbidity Index (CCI) and renal score. …

Floor Of Mouth Thyroglossal Duct Cyst: A Rare Embryologic Course., John Kerr, Weston L Niermeyer, Peter B Baker, Tendy Chiang

Surgery Articles

A thyroglossal duct cyst (TGDC) is a common pediatric midline neck mass. Most TGDCs occur in the region of the hyoid bone but have been found less commonly in areas from the oral cavity to the sternum. We present the first reported case of a multifocal floor of mouth (FOM)/cervical TGDC representing an atypical embryonic course. We also review atypical presentations of TGDC and provide a summary of cases involving FOM and multifocal cysts.