Surgery Commons^™

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 …

A Modular Surgical Simulator For Microlaryngoscopy Using Standard Instruments And The Carbon Dioxide Laser, Sara E. Bressler, Lacey K. Adkins, Michael E. Dunham, Rohan R. Walvekar, Jangwook P. Jung, Jorge A. Belgodere, Adam X. Bao, Lizabeth S. Breaux, Hunter C. Lee, Soheil Saneei, Austin P. Veal, John S. Carleton

School of Medicine Faculty Publications

Objective: Build a microlaryngoscopy surgical simulator for endoscopic laryngeal surgery using standard microsurgical instruments and a CO2 laser. Study design: Anatomical modeling, CAD design and 3D printed manufacturing. Subjects and methods: We created a modular design for a microlaryngoscopy simulator in CAD software. Components include plastic and stainless-steel models of a standard operating laryngoscope and a cassette system for mounting porcine or synthetic models of the vocal folds. All simulator parts, including the metallic laryngoscope model, were manufactured using 3D printing technology. Tumors were simulated in porcine tissue models by injecting a soy protein-based tumor phantom. Residents and faculty in …

Emerging Applications Of Contrast-Enhanced Ultrasound In Trauma, Brenda Tester, Ji-Bin Liu, John R. Eisenbrey, George Koenig

Department of Radiology Faculty Papers

The use of contrast-enhanced ultrasound (CEUS) has expanded over the past decade to include a variety of diagnostic and therapeutic applications. These include urgent clinical situations that require timely diagnosis and subsequent treatment. With the introduction of microbubble ultrasound contrast agents (UCAs), CEUS provides increased sensitivity and specificity over conventional ultrasound. Within the trauma setting, CEUS benefits include point of care imaging and an ability to monitor perfusion in real-time. Additionally, UCAs are non-nephrotoxic, and can be used when contrast enhanced CT is contraindicated. In this review, we discuss recent advancements of CEUS within trauma settings.

Popliteal Artery Entrapment Syndrome Treated By A Posterior Approach In A 15-Year-Old Athlete, Lili Sadri, Robert L Myers, Casey Paterson, Quyngdiem Lam, Danielle M Pineda

Department of Surgery Faculty Papers

Popliteal artery entrapment syndrome is a rare source of claudication in young people. We present the case of a 15-year-old male athlete who presented with intermittent numbness of his right foot with exertion. Imaging revealed classic compression from a right type III popliteal artery entrapment. The left popliteal artery was chronically occluded with a large collateral vessel. He underwent release of the accessory bands of the gastrocnemius muscle with significant arteriolysis on the right side via a posterior approach. Chronic popliteal artery entrapment can be treated from a posterior approach, resulting in arterial occlusion and will be asymptomatic if well …

Podium Presentation: Opioid Use Among Total Knee Arthroplasty Patients, Kelsie Welle, Karen Colorafi, Kenn Daratha

2022 Providence Nurse Research Conference

No abstract provided.

Will Apfel Score Awareness Among Caregivers Improve Postoperative Nausea And Vomiting (Ponv) Incidence And Management In Day Surgery?, Leni Alejo, Cherry De Guia, Cassandra Luck-Bird, Cynthia Rodriguez, Lilibeth Paloso, Gillian Ramirez, Deborah Graham

2022 Providence Nurse Research Conference

Background: Evidence supports Apfel Simplified Risk Score (SRS) as being effective in predicting postoperative nausea and vomiting (PONV) in patients following general anesthesia. Raising awareness of a person’s risk for PONV allows for prescription of antiemetics based on the Apfel SRS. Clinical Practice Guidelines (CPGs) for the management of PONV highlight first identifying patients’ risk to better manage anesthesia side effects. A team of nurses working in a tertiary hospital in Texas led a project using the Apfel SRS to improve PONV management.

Purpose: To raise awareness of patients' PONV risk perioperatively to improve patient outcomes of PONV events, prophylactic …

Identifying Skin Integrity Issues In The Post Anesthesia Care Unit: A Qualitative Improvement Project, Lori Patten

2022 Providence Nurse Research Conference

No abstract provided.

Criminal, Legal, And Ethical Kidney Donation And Transplantation: A Conceptual Framework To Enable Innovation, Alvin E Roth, Ignazio R Marino, Kimberly D Krawiec, Michael A Rees

Department of Surgery Faculty Papers

No abstract provided.

An Unusual Case Of Perforated Appendicitis In Situs Inversus Totalis In Indonesia, Valencia J. Martin, Imanuel T. Parinding

The New Ropanasuri Journal of Surgery

Situs inversus is a rare congenital anomaly where the internal organs are transposed in a mirror image. It is commonly unrecognized until a patient comes with a complaint, especially in developing countries where people do not have a routine medical checkup. We report a case of a young female with unusual left lower quadrant pain abdominal pain. Perforated appendicitis leading to peritonitis was confirmed using ultrasonography and successfully treated with laparotomy. Appendicitis should be considered a working diagnosis in lower left quadrant abdominal pain

Review: Partial Splenic Embolization Outcome On Liver Cirrhosis With Esophageal Varices, Raden Suhartono, Muhammad F. A Irsal

The New Ropanasuri Journal of Surgery

Introduction. Liver cirrhosis may be followed by complications such as esophageal varices for 30 days mortality rate up to 15-20%. Partial splenic embolism (PSE) or partial splenic embolization has been developed as a safe and effective alternative therapy for managing bleeding in esophageal varices. This study aims to determine the outcome of PSE in patients with liver cirrhosis with esophageal varices.

Method. In this review, the literature search proceeded on three online databases (Cochrane Library, MEDLINE (PubMed), and ScienceDirect) according to PRISMA protocol. Through selections, six articles were included, and all were the reports.

Results. Of six reports, three were …

Revascularization Techniques For Infra-Popliteal Peripheral Artery Disease In Diabetic Foot: A Literature Review, Raden Suhartono, Ghany H. Wijaya

The New Ropanasuri Journal of Surgery

Foot ulcers are one of the problems that are often encountered in uncontrolled diabetes mellitus. With diabetic peripheral neuropathy, the typical clinical symptoms of PAD (peripheral arterial disease) may be obscured, leading to critical limb ischemia (CLTI). Diabetes may accelerate atherosclerosis that diminishes blood flow in PAD—further, diabetic patients with PAD often enfaces infra-popliteal lesions and require revascularization. However, studies on revascularization techniques in infra-popliteal PAD remain minimal. We reviewed the literature on EBSCO, and PubMed focused on the revascularization techniques in PAD, namely: expanded polytetrafluoroethylene (ePTFE), saphenous vein graft (SVG), atherectomy, surgical revascularization first, revascularization with endovascular bypass, direct …

Effect Of Ischemia-Reperfusion Injury And Preconditioning On Lung Parenchyma After Acute Limb Ischemia, David Hutagaol, Dhama S. Susanti, Wuryantoro Soeharto, Muhammad A. Putra, Suprayitno Wardoyo, William Makdinata, Moira Setiawan

The New Ropanasuri Journal of Surgery

Introduction. Acute limb ischemia, a sudden decrease of perfusion to the extremities, can compromise the survival of the limbs. Medical intervention and surgery are often needed to return perfusion. However, reperfusion injury can trigger oxidative stress and inflammatory response, leading to local and remote tissue damage, such as the lungs, which increases morbidity and mortality. This research aims to study the effects of hypothermia and remote ischemic preconditioning (RIPC) on the lung parenchyma after being exposed to reperfusion after acute limb ischemia in rabbits.

Method. Eighteen New Zealand White rabbits were divided into three groups of 6. The …

Review: Conventional Thrombectomy With Intraoperative Fluoroscopy In Acute Limb Ischemia Rutherford Iib, Heru Angkoso, Dedy Pratama

The New Ropanasuri Journal of Surgery

Introduction. Acute limb ischemia (ALI) is a severe condition affecting the extremities and the patient’s survival that requires immediate treatment. It can be treated with either surgical or endovascular revascularization or both (hybrid procedure). It is crucial to evaluate the defect using intraoperative fluoroscopy or angiography in each case. The review aimed to find out the outcomes of the thrombectomy with intraoperative fluoroscopy for ALI Rutherford IIb.

Method. According to the PRISMA protocol, the literature search proceeded in online databases, i.e., Cochrane, Scopus, PubMed, and EBSCOhost, with no year limitation on the publication. All articles were screened and critically appraised. …

Mini-Review: Omental Patch Repair Of Giant Perforated Peptic Ulcer, Ridho A. Syaiful, Muhammad F. Agustian

The New Ropanasuri Journal of Surgery

Introduction. A perforated giant peptic ulcer is an emergency that requires surgery. Closure of the perforation with an omental patch has been reported in several cases of perforated giant peptic ulcers. However, there is insufficient evidence regarding the option of preferred treatment. This review to discuss published reports of a perforated giant peptic ulcer closed with an omental patch that focused on the complications

Method. The literature search was conducted through the Cochrane, PubMed, Scopus, and EBSCO data sites. The articles obtained were screened for duplication, title, abstracts, and full-text based on inclusion and exclusion criteria.

Result: Two articles were …

Review: Management Of Complex Anal Fistula, Agi S. Putranto, Winda J. Layardi

The New Ropanasuri Journal of Surgery

Introduction. Complex anal fistula has a high postoperative recurrence rate and incontinence as well. There have been many emerging surgical techniques, but there are no new recommendations for managing complex anal fistula. One of the critical parameters in evaluating surgical technique outcomes is the recurrence rate and incontinence. This study describes postoperative results in recurrence rates and incontinence in various surgical techniques in managing complex anal fistula.

Method. This review commenced with literature searches on online databases, including Cochrane Library, MEDLINE (PubMed), ScienceDirect, and CINAHL (EBSCOhost).

Results. The study enrolled two RCTs, four systematic reviews, 14 retrospective and prospective studies, …

Graduated Compression Stockings For Deep Vein Thrombosis Prevention In Surgical Patients: A Systematic Review, Dedy Pratama, Satria M.H Simatupang

The New Ropanasuri Journal of Surgery

Introduction. Oral anticoagulant therapy is commonly used to prevent deep vein thrombosis (DVT). However, it might increase the risk of intraoperative and postoperative bleeding. Graduated compression stockings (GCS) reduced DVT risk, but there is a lack of supporting evidence. Thus, the study aimed to find the efficacy of GCS compared to the pharmacological method in high-risk surgical patients.

Method. Literature search proceeded in Cochrane, ClinicalKey, and PubMed. Using keywords graduated compression stockings" or "mechanic" or mechanical") and ("pharmacologic" or "oral anticoagulants" or "NOAC") and "comparison" and "prophylaxis" and ("DVT" or "deep vein thrombosis) and ("surgery" or "surgical").

Results …

Risk Of Upper Extremity Musculoskeletal Injury In Laparoscopy Training, Theddeus Oh Prasetyono, Christopher R. Andrian, Elisabet La Kinanthi

The New Ropanasuri Journal of Surgery

Introduction. The laparoscopy procedure still has an ergonomic burden that can increase the risk of musculoskeletal injury, especially in the upper extremity. Furthermore, the risk is compounded in laparoscopic training as the trainees have to repeat the same movements many times to achieve competencies. This study revealed the relation between the position and the risk of musculoskeletal injury in laparoscopy training.

Methods. A cross-sectional study on nine subjects was conducted during laparoscopy training. By fixing the table height at 77 cm, we measured the operator height and upper extremity positions to relate them to their VAS and DASH scores.

Results. …

Serum Cea Level In Predicting Liver Metastases Of Colorectal Cancer Among Young Adult Patients, Ely S.P Sihotang, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction: Incidence and mortality of CRC are currently increasing in those under 50 years. The study aims to determine the predictive value of serum CEA levels as the liver metastases predictor of colorectal cancer (CRC) in young adults.

Methods: A cross-sectional study was conducted using secondary data (patient medical records) from 2015–to 2021. Patients aged <50 years who were diagnosed histopathologically with primary colorectal cancer at dr. Cipto Mangunkusumo General Hospital (CMGH) were recruited. We excluded patients with a history of other malignancies, who had undergone operative management for colorectal cancer, and preexisting liver disease. The outcome of this study is the cut-off of the CEA value obtained by the ROC curve and the sensitivity and specificity of the CEA value in predicting CR liver metastases.

Results: Out of 181 subjects enrolled, a total of 43.6% were female. Fifty-nine subjects (32.6%) had liver metastases. The CEA level of the metastases group was 208.1 (2.1–12503.2) ng/mL; this was much higher than the non-metastases group, which was 6.27 (0.8– 1099.4) …

Does Individualized Guided Selection Of Antiplatelet Therapy Improve Outcomes After Percutaneous Coronary Intervention? A Systematic Review And Meta-Analysis, Naser Yamani, Samuel Unzek, Muhammad Hasnain Mankani, Talal Almas, Adeena Musheer, Humera Qamar, Shausha Farooq, Waqas Shahnawaz, Kaneez Fatima, Vincent Figueredo

Department of Medicine

Background: The potential benefits of individualized guided selection of antiplatelet therapy over standard antiplatelet therapy in improving outcomes in patients undergoing percutaneous coronary intervention (PCI) have not been established. Therefore, we pooled evidence from available clinical trials to assess the effectiveness by comparing the two regimens in patients undergoing PCI.
Methods: We queried two electronic databases, MEDLINE and Cochrane CENTRAL, from their inception to April 20, 2021 for published randomized controlled trials in any language that compared guided antiplatelet therapy, using either genetic testing or platelet function testing, versus standard antiplatelet therapy in patients undergoing PCI. The results from trials …

Fondaparinux As An Alternative Anticoagulant Treatment In Patients With Left Ventricular Assist Devices And Recurrent Gastrointestinal Bleeding: Case Series, Daniela Piani, Andrea Lechiancole, Massimo Maiani, Igor Vendramin, Sandro Sponga, Elisabetta Auci, Ugolino Livi

The VAD Journal

Gastrointestinal bleeding (GIB) can occur in patients after left ventricular assist device (LVAD) implantation. In cases of recurrent GIB, the management of anticoagulation treatment represents a challenging situation in which the risk of bleeding recurrence and the need for long-term anticoagulation must be balanced. This case series describes the successful management of anticoagulation in three patients with recurrent GIB using fondaparinux.

To our knowledge, these are the first reported cases of recurrent GIB in which a single dose of subcutaneous fondaparinux was used instead of oral anticoagulation. None of the patients presented with signs of pump thrombosis or arterial embolism. …