The Experts below are selected from a list of 873 Experts worldwide ranked by ideXlab platform
H L Evans - One of the best experts on this subject based on the ideXlab platform.
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reconstruction of the symphysis pubis to repair a complex midline hernia in the setting of congenital bladder exstrophy
Hernia, 2015Co-Authors: J E Kohler, Micah A Jacobs, Jonathan Friedstat, Bryan B Voelzke, Joseph S Gruss, Richard W Grady, H L EvansAbstract:Purpose A 40-year-old man with congenital midline defect and wide pubic symphysis diastasis secondary to bladder exstrophy presented with a massive incisional hernia resulting from complications of multiple prior abdominal repairs. Using a multi-disciplinary team of general, plastic, and urologic surgeons, we performed a complex hernia repair including creation of a pubic symphysis with Rib Graft for inferior fixation of mesh.
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reconstruction of the symphysis pubis to repair a complex midline hernia in the setting of congenital bladder exstrophy
Hernia, 2015Co-Authors: J E Kohler, Micah A Jacobs, Jonathan Friedstat, Bryan B Voelzke, Joseph S Gruss, Richard W Grady, H M Foy, H L EvansAbstract:A 40-year-old man with congenital midline defect and wide pubic symphysis diastasis secondary to bladder exstrophy presented with a massive incisional hernia resulting from complications of multiple prior abdominal repairs. Using a multi-disciplinary team of general, plastic, and urologic surgeons, we performed a complex hernia repair including creation of a pubic symphysis with Rib Graft for inferior fixation of mesh. The skin Graft overlying the peritoneum was excised, and the posterior rectus sheath mobilized, then re-approximated. The previously augmented bladder and urethra were mobilized into the pelvis, after which a Rib Graft was constructed from the 7th Rib and used to create a symphysis pubis using a mortise joint. This Rib Graft was used to fix the inferior portion of a 20 × 25 cm porcine xenoGraft mesh in a retro-rectus position. With the defect closed, prior skin scars were excised and the wound closed over multiple drains. The patient tolerated the procedure well. His post-operative course was complicated by a vesico-cutaneous fistula and associated urinary tract and wound infections. This resolved by drainage with a urethral catheter and bilateral percutaneous nephrostomies. The patient has subsequently healed well with an intact hernia repair. The increased intra-abdominal pressure from his intact abdominal wall has been associated with increased stress urinary incontinence. Although a difficult operation prone to serious complications, reconstruction of the symphysis pubis is an effective means for creating an inferior border to affix mesh in complex hernia repairs associated with bladder exstrophy.
Nivaldo Alonso - One of the best experts on this subject based on the ideXlab platform.
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modified technique to increase nostril cross sectional area after using Rib and septal cartilage Graft over alar nasal cartilages
Acta Cirurgica Brasileira, 2012Co-Authors: Marcelo Wulkan, Alvaro Julio De Andrade Sa, Nivaldo AlonsoAbstract:PURPOSE: DescRibe a modified technique to increase nostril cross-sectional area using Rib and septal cartilage Graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage Grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad®; 30 were taken before any procedure and 60 were taken after Grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". RESULTS: There's statistical evidence that Rib cartilage Graft is more effective than septal cartilage Graft. The mean area after the insertion of septal cartilage Graft is smaller than the mean area under Rib Graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage Graft over lateral crura rather than by septal Graft.
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Modified technique to increase nostril cross-sectional area after using Rib and septal cartilage Graft over alar nasal cartilages Técnica modificada para aumentar a área seccional externa da narina após o uso de enxerto cartilaginoso de costela e septo sob as cartilagens alares nasais
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2012Co-Authors: Marcelo Wulkan, Alvaro Julio De Andrade Sa, Nivaldo AlonsoAbstract:PURPOSE: DescRibe a modified technique to increase nostril cross-sectional area using Rib and septal cartilage Graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage Grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad®; 30 were taken before any procedure and 60 were taken after Grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". RESULTS: There's statistical evidence that Rib cartilage Graft is more effective than septal cartilage Graft. The mean area after the insertion of septal cartilage Graft is smaller than the mean area under Rib Graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage Graft over lateral crura rather than by septal Graft.OBJETIVO: Descrever uma técnica modificada para se aumentar a área seccional externa da narina com cartilagem septal e costal acima das cartilagens alares nasais. MÉTODOS: Utilizou-se uma técnica cirúrgica modificada para obter, esculpir e inserir enxertos de cartilagem sobre as cartilagens alares. Realizou-se fotos padronizadas e mensuração de 90 áreas seccionais externas de narina em cadáveres com Autocad®; 30 antes sem procedimento; 60 após a inclusão de enxertos sob a cruz lateral (30 usando cartilagem costal e 30 usando cartilagem septal). A análise estatística foi feita com um modelo de medidas repetidas e ANOVA para a variável "área" RESULTADOS: Existe evidência estatística de que o enxerto de cartilagem costal é mais efetivo que o enxerto de cartilagem septal. A área média após a inclusão do enxerto de septo é menor que a observada após a inclusão de enxerto de costela (intervalo de confiança para a diferença de médias não inclui o valor de zero e todos os valores de P são abaixo do nível significativo de 5%). CONCLUSÕES: A técnica descrita é aplicável em cadáveres para aumento da área seccional externa da narina. Esta técnica modificada revelou ser mais efetiva com o uso de cartilagem costal do que septal
J E Kohler - One of the best experts on this subject based on the ideXlab platform.
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reconstruction of the symphysis pubis to repair a complex midline hernia in the setting of congenital bladder exstrophy
Hernia, 2015Co-Authors: J E Kohler, Micah A Jacobs, Jonathan Friedstat, Bryan B Voelzke, Joseph S Gruss, Richard W Grady, H L EvansAbstract:Purpose A 40-year-old man with congenital midline defect and wide pubic symphysis diastasis secondary to bladder exstrophy presented with a massive incisional hernia resulting from complications of multiple prior abdominal repairs. Using a multi-disciplinary team of general, plastic, and urologic surgeons, we performed a complex hernia repair including creation of a pubic symphysis with Rib Graft for inferior fixation of mesh.
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reconstruction of the symphysis pubis to repair a complex midline hernia in the setting of congenital bladder exstrophy
Hernia, 2015Co-Authors: J E Kohler, Micah A Jacobs, Jonathan Friedstat, Bryan B Voelzke, Joseph S Gruss, Richard W Grady, H M Foy, H L EvansAbstract:A 40-year-old man with congenital midline defect and wide pubic symphysis diastasis secondary to bladder exstrophy presented with a massive incisional hernia resulting from complications of multiple prior abdominal repairs. Using a multi-disciplinary team of general, plastic, and urologic surgeons, we performed a complex hernia repair including creation of a pubic symphysis with Rib Graft for inferior fixation of mesh. The skin Graft overlying the peritoneum was excised, and the posterior rectus sheath mobilized, then re-approximated. The previously augmented bladder and urethra were mobilized into the pelvis, after which a Rib Graft was constructed from the 7th Rib and used to create a symphysis pubis using a mortise joint. This Rib Graft was used to fix the inferior portion of a 20 × 25 cm porcine xenoGraft mesh in a retro-rectus position. With the defect closed, prior skin scars were excised and the wound closed over multiple drains. The patient tolerated the procedure well. His post-operative course was complicated by a vesico-cutaneous fistula and associated urinary tract and wound infections. This resolved by drainage with a urethral catheter and bilateral percutaneous nephrostomies. The patient has subsequently healed well with an intact hernia repair. The increased intra-abdominal pressure from his intact abdominal wall has been associated with increased stress urinary incontinence. Although a difficult operation prone to serious complications, reconstruction of the symphysis pubis is an effective means for creating an inferior border to affix mesh in complex hernia repairs associated with bladder exstrophy.
Wulkan Marcelo - One of the best experts on this subject based on the ideXlab platform.
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A comparative study on cadavers of the use of septal and Rib cartilage Grafts to increase nostril cross-sectional area
'Universidade de Sao Paulo Agencia USP de Gestao da Informacao Academica (AGUIA)', 2013Co-Authors: Wulkan MarceloAbstract:INTRODUÇÃO: A área da seccção externa da narina é a parte inferior da válvula nasal externa que é o primeiro obstáculo ao fluxo de ar. Existem dúvidas e controvérsias em relação a eficácia de tratamentos cirúrgicos nessa região do nariz durante a rinoplastia. Neste estudo, compararam-se em cadáveres o uso do enxerto de reforço alar modificado de cartilagem septal e costal para analisar o aumento da área seccional externa narinária. MÉTODOS: Trinta narinas de cadáveres foram dissecados no Serviço de Verificação de Óbito da Capital- Universidade de São Paulo. A escolha dos cadáveres foi aleatória (9 mulheres e 6 homens) excluíndo-se os casos com lesão deformante nasal ou doença intra-nasal. Todos os enxertos septais e costais apresentavam as mesmas dimensões (30 x 5 x 1 mm) e foram inseridos acima do ramo lateral das cartilagens alares de maneira aleatória. A seguir, realizaram-se fotos padronizadas e mensurações das 90 áreas seccionais externas de narina com o programa Autocad®; 30 antes de qualquer procedimento; 60 após a inclusão de enxertos (30 usando cartilagem costal e 30 usando cartilagem septal). A análise estatística foi feita com um modelo de medidas repetidas e ANOVA (análise de variância) para a variável área. A comparação das médias foi feita pelo método de Tukey, sendo o coeficiente de confiança global de 95%. RESULTADOS: A área seccional externa da narina sem tratamento, com inclusão de enxerto de reforço alar modificado septal e costal é, respectivamente, 0,76 cm2, 0,85 cm2 (aumento de 11,8%) e 0,91 cm2 (aumento de 19,7%). CONCLUSÃO: O enxerto de reforço alar modificado de costela é estatisticamente mais efetivo que o enxerto de reforço alar modificado de septo para aumentar a área de secção externa da narinaINTRODUCTION: The nostril cross-sectional area (bottom of the external nasal valve) presents the first obstacle to airflow. There are doubts and controversies regarding the effectiveness of surgical treatments in this region of the nose during a rhinoplasty. In this study, we have tested two modified strategies for alar reinforcement, one using a cartilage Graft from the nasal septum and the other using Rib cartilage, to analyze and compare their effectiveness in augmenting nostril cross-sectional area. METHODS: Thirty corpses nostrils were dissected in the Division of Postmortem Inspection at the University of São Paulo. Corpses were chosen at random (9 women and 6 men) excluding those with deforming nasal injury or intra-nasal disease. All nasal septum and Rib Grafts had the same dimensions (30 x 5 x 1 mm) and were inserted randomly above the lateral crura of the alar cartilages. Then, a total of 90 standardized photographs were taken to measure nostril cross-sectional area using the Autocad® program; one per nostril on all 15 cadavers, at three separate intervals. Thirty photos were taken prior to any procedure being performed, and 60 after the insertion in each nostril, of the two different types of cartilage Grafts. After one Graft was tested, it was removed and replaced with the other type. The order of the procedures was randomized. Statistical analyses were conducted using a model for repeated measures and ANOVA for the variable area. The comparison of means was done with Tukeys method and a 95% confidence coefficient. RESULTS: The nostril cross-sectional area before treatment, after modified alar reinforcement using septum cartilage Graft, and after modified alar reinforcement using Rib Graft were 0,76 cm2, 0,85 cm2 (increase of 11,8%) and 0,91 cm2 (increase 19.7%), respectively. CONCLUSION: The modified alar reinforcement using Grafts of Rib cartilage is statistically more effective than the modified alar reinforcement using Grafts of nasal septum in increasing the nostril cross-sectional are
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Técnica modificada para aumentar a área seccional externa da narina após o uso de enxerto cartilaginoso de costela e septo sob as cartilagens alares nasais
SAO PAULO, 2012Co-Authors: Wulkan Marcelo, Sa, Alvaro Julio De Andrade, Alonso NivaldoAbstract:PURPOSE: DescRibe a modified technique to increase nostril cross-sectional area using Rib and septal cartilage Graft over alar nasal cartilages. METHODS: A modified surgical technique was used to obtain, carve and insert cartilage Grafts over alar nasal cartilages. This study used standardized pictures and measured 90 cadaveric nostril cross-sectional area using Autocad (c); 30 were taken before any procedure and 60 were taken after Grafts over lateral crura (30 using costal cartilage and 30 using septal cartilage). Statistical analysis were assessed using a model for repeated measures and ANOVA (Analysis of Variance) for the variable "area". RESULTS: There's statistical evidence that Rib cartilage Graft is more effective than septal cartilage Graft. The mean area after the insertion of septal cartilage Graft is smaller than the mean area under Rib Graft treatment (no confidence interval for mean difference contains the zero value and all P-values are below the significance level of 5%). CONCLUSIONS: The technique presented is applicable to increase nostril cross section area in cadavers. This modified technique revealed to enhance more nostril cross section area with costal cartilage Graft over lateral crura rather than by septal Graft.OBJETIVO: Descrever uma técnica modificada para se aumentar a área seccional externa da narina com cartilagem septal e costal acima das cartilagens alares nasais. \ud MÉTODOS: Utilizou-se uma técnica cirúrgica modificada para obter, esculpir e inserir enxertos de cartilagem sobre as cartilagens alares. Realizou-se fotos padronizadas e mensuração de 90 áreas seccionais externas de narina em cadáveres com Autocad®; 30 antes sem procedimento; 60 após a inclusão de enxertos sob a cruz lateral (30 usando cartilagem costal e 30 usando cartilagem septal). A análise estatística foi feita com um modelo de medidas repetidas e ANOVA para a variável "área" \ud RESULTADOS: Existe evidência estatística de que o enxerto de cartilagem costal é mais efetivo que o enxerto de cartilagem septal. A área média após a inclusão do enxerto de septo é menor que a observada após a inclusão de enxerto de costela (intervalo de confiança para a diferença de médias não inclui o valor de zero e todos os valores de P são abaixo do nível significativo de 5%). \ud CONCLUSÕES: A técnica descrita é aplicável em cadáveres para aumento da área seccional externa da narina. Esta técnica modificada revelou ser mais efetiva com o uso de cartilagem costal do que septal
John P Dahl - One of the best experts on this subject based on the ideXlab platform.
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endoscopic posterior cricoid split with costal cartilage Graft a fifteen year experience
Laryngoscope, 2017Co-Authors: John P Dahl, Patricia L Purcell, Sanjay R Parikh, Andrew F InglisAbstract:Objective To evaluate outcomes of the endoscopic posterior cricoid split with Rib Graft (EPCS/RG) procedure in the treatment of subglottic stenosis (SGS), posterior glottic stenosis (PGS), and bilateral vocal fold immobility (BVFI). Study Design Retrospective chart review. Methods Chart review of all patients who underwent EPCS/RG at a single tertiary-care facility between 1999 and 2014. Patients were grouped based on the primary indication for the procedure. Decannulation was the primary endpoint. Secondary endpoints were the number of subsequent airway procedures and length of hospitalization. Results Thirty-three patients were identified; 32 had tracheotomy. Overall decannulation rate was 65.6%. Subgroup analysis demonstrated the following decannulation rates: 53.8% for SGS, 100% for PGS, and 28.6% for BVFI. Fisher exact test found a significant difference in overall decannulation rates between groups (P = 0.002). Operation-specific decannulation rates for patients who never required an open procedure were 23% for SGS, 91.6% for PGS, and 28.6% for BVFI. This difference was also statistically significant (P = 0.001). Multivariate logistic regression analysis found prematurity had a positive correlation with decannulation that approached statistical significance (P < 0.051; odds ratio 6.1; 95% confidence interval 0.99, 37.6). The percentage of patients who underwent repeat airway procedures for the groups was 61.5% for SGS, 16.6 % for PGS, and 14.3% for BVFI. The median length of hospitalization after EPCS/RG was 3 days. Conclusion This represents the largest series of patients who have undergone EPCS/RG and demonstrates that the majority of patients can be decannulated after this procedure. Patients with PGS had the highest operation-specific decannulation rates. Level of Evidence 4. Laryngoscope, 2016
