Background: Virtual surgical planning (VSP), computer aided design/computer aided modeling, and 3-dimensional printing technology have been shown to improve surgical accuracy and efficiency in head and neck reconstruction. However, persisting criticism of the technology is that it does not adequately address the soft tissue-related aspects of reconstructive surgery. Prior publication on the computed tomographic angiography (CTA) perforator localization technique has demonstrated how soft tissue planning can be incorporated directly into existing VSP workflows.
Purpose: The aim of this study is to prospectively assess the accuracy, precision, negative predictive value (NPV), and positive predictive value (PPV) of the CTA perforator localization technique for VSP of osteocutaneous fibular free flaps.
Materials And Methods: A prospective observational study in a consecutive cohort of subjects undergoing VSP of osteocutaneous fibular free flaps at Mayo Clinic between 2018 and 2020 was completed. All cutaneous perforators from the peroneal system of the selected donor leg were identified preoperatively through a previously reported CTA tracing method and registered into the VSP. Perforators were classified as primary or secondary based on whether the perforators were targeted for use in the final reconstructive plan. Perforator measurements obtained from the VSP were cross-referenced with intraoperatively obtained measurements of actual perforator locations to calculate accuracy, precision, NPV, PPV, sensitivity, and specificity of the CTA localization technique.
Results: Sixty consecutive subjects were enrolled in the study. A total of 141 perforators were identified preoperatively on CTA and 145 perforators were identified on operative exposure. One perforator identified on preoperative CTA was not identified on surgical exposure (false positive perforator). Six perforators were identified on operative exposure alone without recognition on preoperative CTA (false negative perforators). The accuracy of CTA perforator identification was 96.52%. Median precision of perforator localization was 0.3 cm (standard deviation 0.40) between CTA and operatively identified locations. PPV of the technique was 99.29% and NPV was 90.00%.
Conclusion: The CTA localization technique for identifying and incorporating cutaneous perforator locations into VSP of osteocutaneous fibular free flaps is a reliable, accurate, and precise technique to employ in the modern paradigm of guided surgery for head and neck reconstruction.
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http://dx.doi.org/10.1016/j.joms.2022.03.018 | DOI Listing |
Otolaryngol Head Neck Surg
December 2024
Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Objective: The butterfly cartilage inlay technique was originally developed for repairing small tympanic membrane (TM) perforations but is now increasingly used for repairing large TM perforations. Although studies have evaluated the effectiveness of butterfly tympanoplasty for repairing medium-to-large-sized TM perforations, no study has compared its effectiveness with that of the conventional underlay cartilage technique. Therefore, we aimed to evaluate the effectiveness of butterfly tympanoplasty for repairing medium-to-large-sized TM perforations compared with that of the conventional underlay cartilage.
View Article and Find Full Text PDFPrimary gastric T-cell lymphomas (PGTL) are exceedingly rare with an estimated incidence of 0.0091 per 100,000 person-years, affecting mainly elderly males. PGTL can present with a variety of gastrointestinal symptoms, but patients only rarely present with perforation.
View Article and Find Full Text PDFInt J Surg Case Rep
December 2024
Department of Surgery, Osaka City Juso Hospital, Osaka, Japan.
Introduction And Importance: Type 1 gallbladder perforation (GBP) in the free abdominal cavity causes pan-peritonitis, which is both rare and difficult to diagnose.
Case Presentation: An 80-year-old man presented to our hospital with acute left upper abdominal pain. Twenty days prior to presentation, he had been admitted for 12 days with coronavirus disease 2019 (COVID-19).
Cureus
November 2024
General Surgery, Unidade Local de Saúde de São José, Lisbon, PRT.
Valentino's syndrome is a rare but potentially lethal differential diagnosis for acute appendicitis. We herein present the case of a 22-year-old male patient who presented to the emergency department with acute abdominal pain. Clinical suspicion of acute appendicitis was corroborated by analytical and imaging findings.
View Article and Find Full Text PDFWorld J Gastrointest Surg
December 2024
Department of Gastrointestinal Surgery, Meizhou People's Hospital, Meizhou 514031, Guangdong Province, China.
Background: Gastric mucosal heterotopia (GMH) is a rare, typically asymptomatic condition characterized by ectopic gastric mucosa in tissues outside the stomach. However, it can lead to severe complications, including small intestinal perforation. This case report highlights the unique clinical presentation of GMH-induced recurrent small intestinal perforations, which has been rarely documented.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!