Surgical Procedures, Operative Commons^™

Factfinders For Patient Safety: Minimizing Complications In Radiofrequency Neurotomy: Part I-Implantable Devices; Part Ii-Preprocedural Bvnrfn Imaging, David Hao, Gerald Yeung, Haewon Lee, Zheyan Chen, Ben Laplante, Paul Kitei, Reza Ehsanian, David Levi

Moss-Magee Rehabilitation Papers

This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding minimizing risks with radiofrequency neurotomy procedures. The evidence in support of the following facts is presented: (1) While data on the safety of radiofrequency neurotomy in patients with implanted devices are limited, the procedure can likely be performed safely with careful adherence to best practices and manufacturer recommendations. (2) Basivertebral nerve radiofrequency neurotomy can be performed safely and effectively at the L3 through S1 vertebral levels. Scrutiny of preprocedural imaging may minimize risk. Although the transpedicular approach is preferred, patient anatomy may dictate a non-transpedicular …

Extensive Spinal Epidural Abscess Evacuated With Unilateral Interlaminar Approach (With Operative Video): Illustrative Case, George A. Crabill, Jack A. Leoni, Kaleb Derouen, Jamieson Glasser, Wesley Shoap, Gabriel Tender

School of Medicine Faculty Publications

BACKGROUND: The authors present the case of a patient with an extensive lumbosacral spinal epidural abscess (SEA) that was successfully evacuated in its entirety with a unilateral interlaminar approach. This is an alternative to wide bony decompression at multiple segments. The surgical approach described decompresses the neural elements while maintaining spinal integrity. OBSERVATIONS: Partial removal of the ligamentum flavum can provide an interlaminar corridor that is sufficient to evacuate extensive SEAs in select patients. LESSONS: This case illustrates a surgical approach that successfully evacuates extensive lumbosacral SEA while respecting spinal integrity. https://thejns.org/doi/abs/10.3171/CASE25646.

Acute Gastropericardial Fistula With Cardiac Tamponade And Septic Pericarditis Due To Helicobacter Pylori–Induced Gastric Ulcer Perforation, Stephen J. Bordes, Christopher D. Oubre, Preethi H. Kanumuri, Nicholas Leblanc, Richard Lewis, Thomas Marsden, Terry Stelly

School of Medicine Faculty Publications

No abstract provided.

Utilizing Femoral Metaphyseal Sleeves In Primary Total Knee Arthroplasty For Post-Traumatic Osteoarthritis: A Case Report, Zachary Sukin, Adam Dentinger, Jeremiah Earl

HCA Healthcare Journal of Medicine

Background

Total knee arthroplasty in younger patients presents a heightened risk of postoperative complications and implant failures compared to older populations, particularly in those with posttraumatic arthritis. These challenges necessitate careful consideration and specialized approaches to optimize the outcomes in this patient demographic.

Case Presentation

A 43-year-old man presented with left knee pain resulting from a traumatic lawn mower injury, causing an intraarticular distal femur, at the age of 6. The injury led to a limb-length discrepancy for which he underwent 2 limb-lengthening procedures in his early 20s. Radiographs demonstrated advanced posttraumatic osteoarthritis, and the patient elected to proceed with …

Cmc Arthroplasty For Treatment Of The Painful And Arthritic Thumb: A Review Of Surgical Treatment Options With Preferred Technique, Jon E. Hammarstedt, Yehuda A. Masturov, Sebastian D. Arango, Jacob Zeitlin, Samuel H. Payne, Mark S. Rekant

Department of Medicine Faculty Papers

Arthritis of the first carpometacarpal joint is a prevalent and often disabling condition for many older adults. The diagnosis is typically established through a comprehensive patient history, physical examination, and confirmatory radiographs. Nonsurgical management with splinting and anti-inflammatory medication has demonstrated effectiveness. Several surgical options have proven effectiveness for those who fail nonsurgical management. Surgical options include silicone implantation, resection arthroplasty, tendon interposition, ligament reconstruction, denervation, and joint implant arthroplasty. In the following review, we will elaborate upon the array of therapeutic approaches, culminating in the delineation of our preferred method.

Comparison Of Anterior And Posterior Surgical Approaches For Cervical Ossification Of The Posterior Longitudinal Ligament Stratified By Spinal Levels: A Systematic Review And Meta-Analysis, Seyed Danial Alizadeh, Sepehr Khosravi, Farzin Farahbakhsh, Vali Baigi, Moein Khormali, Mohsen Hajiqasemi, Zahra Eskandari, Mahgol Sadat Hassan Zadeh Tabatabaei, Amirmahdi Khayyamfar, Mohammad-Rasoul Jalalifar, Sepehr Armaghan, Masoud Pourghahramani Koltapeh, Zahra Ghodsi, Michael G. Fehlings, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Rothman Institute Papers

OBJECTIVE: To compare the outcomes of anterior and posterior surgical approaches for treating cervical ossification of the posterior longitudinal ligament across multiple spinal levels, including 1-2 spinal levels, ≥ 3 levels, or studies that operated on both spinal levels, called mixed spinal levels.

METHODS: A search strategy using pertinent keywords was employed in the MEDLINE, Embase, Scopus, and Web of Science databases. Data on Modified Japanese Orthopaedic Association (mJOA) scores, radiographic outcomes, and complications were extracted. A random-effects meta-analysis, subgroup meta-analysis, and sensitivity analysis were performed.

RESULTS: Among 13 included studies, the anterior approach was statistically associated with improved C2-C7 …

Treatment Of Biopsy-Proven Laryngeal Squamous Cell Carcinoma In Situ, Praneet C. Kaki, Aman M. Patel, Lily Huang, Gavin Turner, Afash Haleem, Jason A. Brant, Robert M. Brody, Ryan M. Carey

SKMC Student Presentations and Publications

OBJECTIVE: To investigate the impact of clinical surveillance, primary radiotherapy, and primary surgery on overall survival (OS) in laryngeal carcinoma in situ (Cis).

METHODS: The 2006-2020 National Cancer Database was queried for adults with a biopsy-proven diagnosis of laryngeal Cis. Multivariable binary logistic and Cox proportional hazards regression models were implemented.

RESULTS: Of 3567 unique patients satisfying inclusion criteria, 514 (14.4%) underwent clinical surveillance, 1074 (30.1%) underwent primary radiotherapy, and 1979 (55.5%) underwent primary surgery. Receiving treatment at an academic/research facility was associated with higher odds of undergoing primary surgery compared to primary radiotherapy. Among 646 patients undergoing primary surgery …

Robotic Ureteral Reconstruction For Endometriosis-Induced Strictures: Insights From A Multi-Institutional Experience, Matthew Lee, Sonam Saxena, Kelley Zhao, Cameron Dodd, Randall Lee, Michael Stifelman, Lee Zhao, Daniel D. Eun

Department of Surgery Faculty Papers

PURPOSE: To investigate outcomes of robotic ureteral reconstruction (RUR) in female patients with ureteral strictures caused by peri-ureteral endometriosis lesions.

METHODS: We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database to identify all consecutive patients undergoing RUR for surgical management of endometriosis-induced ureteral strictures between 2017 and 2022. Indications for surgery included female patients with radiographic evidence of ureteral strictures and/or decreasing renal function on renal scan. We performed a descriptives analysis of perioperative outcomes in patients who met inclusion criteria. Surgical success was defined as freedom from additional interventions for recurrent ureteral stenosis.

RESULTS: Overall, …

Bromelain-Based Enzymatic Debridement Of A Third-Degree Burn To Skin-Grafted Bowel, Shengqing Wang, Janie Faris, Kareem Abdelfattah, Samuel Mandell, M Victoria Miles

School of Medicine Faculty Publications

Burn injuries over previously grafted tissue present a formidable challenge for excision and debridement, particularly when there are critical underlying structures such as bowel. Enzymatic debridement with the recently approved anacaulase-bcdb, a bromelain-based enzymatic debridement gel (Nexobrid), presents an additional method of burn excision that may be useful in such a situation. This brief report presents the management of a complex third-degree burn over a remotely skin-grafted bowel mass using anacaulase-bcdb gel. This report is written with documented patient consent and approval by the Human Research Protection Program office in compliance with institutional policy. A 52-year-old man presented to our …

Rethinking Pain Relief After Surgery: What We Can Learn From Knee Replacements, Asim Trimzi

SKMC Student Presentations and Publications

This paper offers a clear, evidence-based look at how we can reduce opioid use after knee replacement surgery without sacrificing pain relief. This review focuses specifically on total knee arthroplasty (TKA)-one of the most commonly performed and most painful surgeries-and asks whether opioids are truly necessary. By analyzing results from 21 clinical trials, the paper shows that non-opioid medications like NSAIDs and gabapentinoids can provide similar pain control with fewer side effects, such as nausea, dizziness, constipation, and sedation. Lower risk of long-term use is an added benefit. A recent RCT found that after knee/shoulder arthroscopy, 72% of patients in …

Monitoring The Hematologic Markers In Patients Undergoing Single-Stage Exchange Arthroplasty For Periprosthetic Joint Infection, Wenbo Mu, Juan D. Lizcano, Boyong Xu, Wentao Guo, Abudousaimi Aimaiti, Xiaogang Zhang, Javad Parvizi, Li Cao

Rothman Institute Papers

BACKGROUND: Periprosthetic joint infection (PJI) is a serious complication that necessitates a complex treatment strategy. Single-stage exchange arthroplasty, combined with intravenous and intra-articular antibiotic infusions, has shown high efficacy in treating complex PJIs. However, the impact of this approach on hematologic parameters remains underexplored. This study aims to evaluate the postoperative trends in blood platelet count, white blood cell (WBC) count, and neutrophil count in patients undergoing single-stage exchange arthroplasty.

METHODS: A retrospective analysis was conducted on 313 patients who underwent single-stage revision for PJI between June 2010 and October 2022. Hematologic parameters were monitored for the first seven postoperative …

Synthetic Electrospun Fiber Matrix In The Management Of Acute Wounds Following Excision Of Hidradenitis Suppurativa Lesions: A Prospective Pilot Study, Michael Madueke, Frank Lau

School of Medicine Faculty Publications

Hurley Stage II or III hidradenitis suppurativa (HS) may necessitate surgical excision of diseased skin and subcutaneous fat for symptom control and disease management. These excisions result in open wounds in topographically challenging regions and typically cannot be primarily closed. This study evaluates the use of a synthetic electrospun fiber matrix (SEFM) as a post-resection regeneration template to accelerate re-granulation and improve subsequent skin graft incorporation. This prospective pilot study enrolled Hurley Stage II or III patients undergoing surgical resection of HS lesions. SEFM was applied to the resulting wounds in conjunction with negative pressure wound therapy (NPWT). Patients were …

Wernicke’S Encephalopathy With Classic Triad And Normal Mri In A Young Woman Following Rapid-Sequence Bariatric And Biliary Surgery, Hugo Zamarron, Nina Mourao, Roberto A. Cruz Saldana

Research Colloquium

Background: Wernicke’s encephalopathy is a life-threatening neurological disorder caused by thiamine deficiency, most commonly associated with alcoholism. However, postoperative nutritional deficiencies in young patients undergoing bariatric procedures are increasingly recognized. This case is unique due to the rapid succession of bariatric and cholecystectomy surgeries, development of classic Wernicke’s symptoms with a normal MRI, and diagnostic delay due to overlapping differential diagnoses including intracranial hypotension and myelopathy.

Case Presentation: A 22-year-old woman with class III obesity underwent sleeve gastrectomy in July 2022, followed by significant weight loss and persistent intractable vomiting. Due to suspected gallbladder disease, she underwent a cholecystectomy in …

Ethical Issues Involved In Solid Organ Xenotransplantation., Daniel J Hurst, Chris Bobier, Luz A Padilla

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Xenotransplantation (specifically, genetically modified pig-to-human transplant of organs, tissues, or cells) clinical trials are set to begin in the United States after decades of pre-clinical studies and recent decedent and compassionate use investigations. This article provides a primer on the key ethical issues attendant with this emerging therapy. We explore four central areas of concern: (i) the use of animals to meet human transplant needs, as well as their welfare since they are housed in non-natural conditions, (ii) the risk of infectious disease transfer from the porcine graft to the human recipient, known as xenozoonosis, (iii) patient selection criteria for …

In-Hospital Exposure And Opioids Prescribed After Total Knee Arthroplasty, Clifton Daigle, Robert Branstetter, Leland Van Deventer, Ravi Rajendra, Claudia Leonardi, Amy Bronstone, Vinod Dasa

School of Medicine Faculty Publications

BACKGROUND: Opioids are frequently used intraoperatively and during postanesthesia care unit care in total knee arthroplasty (TKA) cases and are commonly prescribed after surgery despite known adverse effects. This study examined whether in-hospital opioid exposure is related to postoperative opioid prescribing in opioid-naïve TKA patients. METHODS: This retrospective study included opioid-naïve patients (no opioid prescriptions filled during the three months before TKA) who had unilateral primary TKA between May 1, 2020, and November 30, 2023, performed by an orthopaedic surgeon. All patients were treated using the same multimodal pain protocol. Opioid prescriptions filled by patients during the three months following …

Increased Risk Of Postoperative Complications In Patients With Hypertension Undergoing Mohs Micrographic Surgery, Alexandra Elder, Henry Yang, Megan O'Donnell-Capelli, Jenna Mandel, Molly Wallace, Lauren Banner, Ramsay Hafer, Thomas Rohan, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Hypertension has been previously associated with higher intraoperative bleeding risk in patients undergoing Mohs micrographic surgery. However, the risks of common postoperative Mohs micrographic surgery complications have not been substantiated by large studies. Our study aimed to assess the risks of common Mohs micrographic surgery complications for patients with hypertension utilizing the TriNetX database, a global health records database encompassing over 105 million patients' data, from January 2009 to January 2024. After 1:1 propensity score matching for age, sex, race, diabetes, nicotine dependence, obesity, and anticoagulant use, the final analysis included 80,739 patients in each cohort of patients with hypertension …

Novel Percutaneous Repair Of Femoral Pseudoaneurysms Using Perclose Proglide™: A Case Series, Ryan Mancoll, Emily Burnett, Nicholas Bandy, Benjamin Samberg, Thomas Cook, Jacob Hoffman, Christopher Murter, Matthew Rossi, David Dexter, Hosam El Sayed, Animesh Rathore Md

Cardiovascular Research Symposium

BACKGROUND - This case series details the novel use of the Perclose ProGlide closure device to successfully repair three separate cases of iatrogenic femoral pseudoaneurysms (PSAs) without attempting other modalities first. Conventional treatment methods of ultrasound-guided compression, duplex-directed thrombin injection (DDTI), or open surgical repair were contraindicated in these patients due to unique anatomy or advanced comorbidities.

METHODS – Details were gathered via a retrospective chart review.

RESULTS - In the first case, a 73-year-old female had an access site PSA off the superficial femoral artery (SFA) with concomitant arteriovenous fistula (AVF) and advanced cardiac disease. The ProGlide device was …

Cardiopulmonary Bypass Facilitates Emergent Tavr And Bifurcation Pci In A Highly Comorbid 72-Year-Old Female With Acute Valvular Shock, Omar Sale Bs, Nicholas Valle Do, Matthew Rossi Md, Joshua Cohen Md, Paul Lavigne Md, Matthew Summers Md

Cardiovascular Research Symposium

Title:

Cardiopulmonary Bypass Facilitates Emergent TAVR and Bifurcation PCI in a Highly Comorbid 72-year-old Female with Acute Valvular Shock

Introduction:

Transcatheter aortic valve replacement (TAVR) has emerged as a critical minimally invasive option for patients with severe AS who present in valvular shock, particularly those at prohibitive surgical risk. Multicenter registry data demonstrate that emergent TAVR in this population is associated with promising procedural success, significant improvements in functional status, and lower short- and long-term mortality compared to medical management or balloon aortic valvuloplasty, with outcomes approaching those of surgical aortic valve replacement in selected patients [1] [2]. We present …

Acute Valve Syndrome And 1-Year All-Cause Mortality Post-Avr: A Retrospective Cohort Study, Omar Sale Bs, Nicholas Valle Do, Israa Saleh, Omar Jafar Md, Matthew Summers Md

Cardiovascular Research Symposium

Background: Acute Valve Syndrome (AVS) identifies a high-risk cohort of aortic stenosis (AS) patients with poor outcomes following aortic valve replacement (AVR), but the spectrum of risk within this group has yet to be fully explored. We sought to evaluate whether admission markers facilitated risk stratification of 1-year mortality in an AVS cohort.

Methods: In a retrospective cohort study (MIMIC-IV v3.1), we identified 2,380 adults who underwent AVR between 2008–2019. Patients were classified as AVS or progressive valvular disease (PVD). AVS was defined by criteria of acute decompensation, including advanced heart failure symptoms, cardiogenic shock, or significant hyperlactatemia. The AVS …

Ai-Guided Simulation And Single-Cusp Cleve To Enable High-Risk Valve-In-Valve Tavr, Joshua Dolsen Md, Omar Sale Bs, Nicholas Valle Do, Matthew Summers Md

Cardiovascular Research Symposium

Title

AI-Guided Simulation and Single-Cusp CLEVE to Enable High-Risk Valve-in-Valve TAVR

Authors

Joshua Dolsen MD, Omar Saleh BSc, Nicholas Valle DO, Matthew Summers MD,

Introduction

Acute coronary obstruction is a rare but potentially fatal complication of transcatheter aortic valve replacement (TAVR), with a markedly increased risk in valve-in-valve (ViV) procedures due to anatomical constraints. The risk is further heightened in patients with complex anatomy, such as low coronary ostia or narrow sinuses of Valsalva. Despite advances in imaging and procedural techniques, pre-procedural risk stratification has remained largely static, relying primarily on pre-procedural imaging with Computed Tomography (CT). Recently, artificial intelligence …