Background And Importance: Giant calcified thoracic discs are challenging surgical pathologies that tend to be more centrally located and calcified. This complicates the removal process and potentiates the formation of dural defects, resulting in persistent cerebrospinal fluid (CSF) leaks and the formation of pleural fistulas. The typical intervention for this is CSF diversion through external ventricular drain or lumbar drain placement, followed by direct repair. However, if all these measures fail, subsequent salvage techniques have not been described previously.
Clinical Presentation: A 45-year-old man with past medical history of obesity (body mass index: 58), hypertension, and type 2 diabetes mellitus presented to the emergency department with thoracic myelopathy symptoms. MR demonstrated a giant calcified thoracic discs at T7-T8 with severe spinal cord compression. Intraoperatively, the disc was found fused to the dura and removal caused a large ventrolateral dural dehiscence. CSF diversion and direct repair were attempted unsuccessfully, so a salvage procedure with a rotational pedicled latissimus dorsi flap was performed. The patient's latissimus dorsi was exposed and resected from attachments, maintaining thoracodorsal blood supply, while removing thoracodorsal innervation. The flap was then rotated into the previous corpectomy site. The dural defect was repaired with a sealant patch, overlayed with a parietal pleural flap and the latissimus dorsi flap. By the patient's last follow-up, he had full functional independence at home.
Conclusion: We present a surgical case highlighting the challenges of managing postoperative CSF-pleural fistula occurring after giant calcified thoracic disc removal and the successful use of a novel rotational latissimus dorsi flap to definitively repair the fistula after unsuccessful primary interventions.
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http://dx.doi.org/10.1227/ons.0000000000001287 | DOI Listing |
Cells
January 2025
Chongqing Academy of Animal Science, Chongqing 402460, China.
Porcine latissimus dorsi muscle (LDM) is a crucial source of pork products. Meat quality indicators, such as the proportion of muscle fibers and intramuscular fat (IMF) deposition, vary during the growth and development of pigs. Numerous studies have highlighted the heterogeneous nature of skeletal muscle, with phenotypic differences reflecting variations in cellular composition and transcriptional profiles.
View Article and Find Full Text PDFJ Cachexia Sarcopenia Muscle
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Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA.
Background: Adeno-associated virus (AAV) 8 and 9 are in clinical trials for treating neuromuscular diseases such as Duchenne muscular dystrophy (DMD). Muscle consists of myofibres of different types and sizes. However, little is known about the fibre type and fibre size tropism of AAV in large mammals.
View Article and Find Full Text PDFArthroscopy
January 2025
Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA USA. Electronic address:
In terms of rotator cuff repair, there is a goal for complete repair and healing, as rotator cuff integrity correlates with clinical and functional results. Retear has been shown to have a significant influence on progression toward osteoarthritis, and patients with an intact supraspinatus show superior abduction and flexion strength. However, in cases where complete repair may not be possible and/or cost limitations may prohibit augmentation, partial repair can provide a respectable outcome.
View Article and Find Full Text PDFJPRAS Open
March 2025
Department of Plastic & Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain.
Introduction: Extensive scalp defects present a significant reconstructive challenge due to the complex needs of patients that are often beyond the scope of conventional therapies, which makes free flaps the most reliable solution. Despite the variety of free flaps available for such cases, there is a lack of clear criteria for selecting the most suitable option. The primary objective of this study was to provide a simplified guide for the selection of donor sites for free flaps for achieving optimal reconstruction outcomes.
View Article and Find Full Text PDFAm J Sports Med
January 2025
Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea.
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Purpose/hypothesis: The purpose of this study was to assess the rates of RTW and RTS and identify associated factors among patients who have undergone LTT transfer for PSIRCTs.
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