Academic literature on the topic 'Surgical technique of pie-crusting'

<p class="abstract"><strong>Background:</strong> Fixed valgus deformity presents a major challenge in total knee arthroplasty (TKA), especially in moderate or severe cases. In knee arthritis, fixed-varus deformity (50 to 55%) is three times more frequent than fixed-valgus deformity (10 to 15%). Valgus deformity occurs more commonly in rheumatoid arthritis and also in osteoarthritis with hypoplasia of the lateral femoral condyle. Valgus deformity is often associated with flexion or external rotation contracture of the knee. In this study we aim to study the surgical outcome of total knee replacement in valgus deformity via standard medial parapatellar approach using various techniques like Pie –Crusting release of lateral structures or combined technique of pie crusting and standard release of lateral structures. Aim: To evaluate surgical outcome of various surgical techniques via standard medial parapatellar approach in fixed valgus deformity in Total Knee Arthroplasty.</p><p class="abstract"><strong>Methods:</strong> The present study involved both male and female patients with osteoarthritis of knee with valgus deformity. In present series, 26 consecutive patients of osteoarthritis with valgus deformity operated with total knee replacement were included. Previously operated cases of high tibial osteotomy and patients having contraindication for TKA were excluded from the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> Valgus angle in this study was between 13 to 27 degree with average 17.84 degree. These results were comparable to many such similar studies. In our study, post operatively, knee society score was average 87.69 and function knee score was 82.5. Mean range of motion was 105 degree. In our study, mean tibiofemoral alignment improved from 17.84 valgus to 4.7 valgus.</p><p class="Default"><strong>Conclusions:</strong> Knee society score is excellent with both techniques and there is no difference in both techniques Iliotibial band and posterolateral capsule are most common structures that require release. Initial ligament balancing should be done with pie crusting and then sequential lateral release if require. </p>

BACKGROUND: Results of surgical treatment of nasal septal perforation are usually evaluated using closure of the perforation as criterion of success. Patients, however, may still have symptoms. AIM: To assess the long-term results of surgical treatment of nasal septal perforation with bilateral, posterior based mucoperichondrial septal flaps using a four-point symptom score to ultimately improve treatment and selection criteria. METHODOLOGY: Patients were seen 6 months postoperatively. Questionnaires were sent to 116 surviving patients in 2008-2009. The response was 104. Patients reporting moderate or severe symptoms were seen as outpatients. RESULTS: Between 1987 and 2004, 126 patients were surgically treated using posterior based bilateral mucoperichondrial septal flaps. Sixteen patients had a reperforation during the first 3 months, and another 3 several years later. There was no correlation between early outcome and diagnosis, preoperative size of the perforation, gender or severity of preoperative crusting. There was an increased rate of reperforation with increasing age. Complications seen at the 6 months` follow-up of patients with closed perforations were lachrymal duct stenosis, partial vestibular stenosis, hypoesthesia, crusting and septal deviation, most of which were treatable. Long-term observation mean 10 years) of the same patients showed the following moderate or severe symptoms: crusting, obstruction and bleeding, mainly in men. Obstruction was often due to various forms of perennial rhinitis, sometimes to crusting and more rarely to septal deviation. Crusting was the only independent symptom. There was no correlation between crusting and diagnosis, preoperative size of the perforation, age or severity of preoperative crusting. CONCLUSIONS: Results of the surgical technique using posterior based bilateral mucoperichondrial septal flaps for treatment of nasal septal perforations were good, but depend on surgical expertise and age of the patient. Long-term results from other studies will be a guide to choose the proper surgical procedure to minimize the number of late symptoms. Prosthetic treatment cans be an alternative. Patients with return of symptoms should seek further advice.

Background: Results of surgical treatment of nasal septal perforation are usually evaluated using closure of the perforation as criterion of success. Patients, however, may still have symptoms. Aim: To assess the long-term results of surgical treatment of nasal septal perforation with bilateral, posterior based mucoperichondrial septal flaps using a four-point symptom score to ultimately improve treatment and selection criteria. Methodology: Patients were seen 6 months postoperatively. Questionnaires were sent to 116 surviving patients in 2008-2009. The response was 104. Patients reporting moderate or severe symptoms were seen as outpatients. Results: Between 1987 and 2004, 126 patients were surgically treated using posterior based bilateral mucoperichondrial septal flaps. Sixteen patients had a reperforation during the first 3 months, and another 3 several years later. There was no correlation between early outcome and diagnosis, preoperative size of the perforation, gender or severity of preoperative crusting. There was an increased rate of reperforation with increasing age. Complications seen at the 6 months` follow-up of patients with closed perforations were lachrymal duct stenosis, partial vestibular stenosis, hypoesthesia, crusting and septal deviation, most of which were treatable. Long-term observation mean 10 years) of the same patients showed the following moderate or severe symptoms: crusting, obstruction and bleeding, mainly in men. Obstruction was often due to various forms of perennial rhinitis, sometimes to crusting and more rarely to septal deviation. Crusting was the only independent symptom. There was no correlation between crusting and diagnosis, preoperative size of the perforation, age or severity of preoperative crusting. Conclusions: Results of the surgical technique using posterior based bilateral mucoperichondrial septal flaps for treatment of nasal septal perforations were good, but depend on surgical expertise and age of the patient. Long-term results from other studies will be a guide to choose the proper surgical procedure to minimize the number of late symptoms. Prosthetic treatment cans be an alternative. Patients with return of symptoms should seek further advice.

Objectives: To assess the efficacy of the technique regarding the surgical outcome, post-operative crusting, and bleeding. Design: Single Blind interventional type of study. Study Place and period: This study was conducted at, Chaudhary Muhammad Akram Teaching and Research Hospital Lahore from July 2018 to June 2019. Material and methods: The study included 100 patients and the results of technique in respect to surgical outcome, the safety of technique regarding post-operative complications like crusting in the postoperative period and epistaxis were analyzed. Results: A total of 100 patients were included for research. Their ages were between 10-40 years. It was concluded that almost all the patients had felt improvement in their nasal blockage and postnasal discharge. The sneezing and headache in these patients also have been improved. Ten patients presented with nose crusting and 4 patient presented with mild epistaxis. No acitve intervention was not required in any patient. Conclusion: It was concluded that reduction of inferior turbinate by Diode laser is an excellent, and safe option, regarding the surgical outcome, and complications faced by patients registered for turbinate surgery. Keywords: Turbinates reduction, Diode laser, epistaxis.

Although inferior turbinectomy with submucosal resection effectively reduces the volume of the inferior turbinate, there is room for improvement in surgical procedures. Techniques have been developed to reduce crusting and bleeding while efficiently achieving volume reduction. State-of-the-art procedures pertaining to the local injection site, incision line, exposure of the periosteum, submucosal outfracture of the turbinate bone, trimming of redundant mucosa, and incision line suturing are described. Pre and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores and postoperative inferior turbinate bleeding and crusting were evaluated. For the 18 consecutive patients analyzed, the pre and postoperative NOSE scores were 67.8 ± 14.8 and 16.1 ± 13.0, respectively ( P = .0002). Postoperatively, bleeding was absent, and only minor suture thread crusting was observed in 13 patients. In conclusion, our novel technique improves the effectiveness of surgery as well as the postoperative quality of the inferior turbinate.

Objective: To compare efficacy of endoscopic turbinoplasty versus conventional inferior turbinectomy for hypertrophy of inferior turbinate. Study Design: Comparative prospective study. Place and Duration of Study: Ear, Nose and Throat (ENT) Department Combined Military Hospital (CMH) Multan, from Jun 2019 to May 2020. Methodology: This study comprised of 50 patients of various age groups and both genders. Patients were grouped into two groups A and B, each group having 25 patients through random sampling. Patients in group A had endoscopic turbinoplasty whereas patients in group B had partial turbinectomy through conventional surgical method. Patients were followed regularly in both groups and were inspected postoperatively at 2 weeks, after 1 month and after 3 months. Results: Patients who underwent Endoscopic turbinoplasty experienced less pain (p˂0.05) postoperatively at 2 weeks compared to conventional surgical turbinectomy. In addition, these patients showed statistically significant healing and reduced crusting at 1 month postoperatively. At 3 months post operatively all patients had healed completely as opposed to only 72% with surgical turbinectomy. Conclusion: Endoscopic turbinoplasty is more effective than conventional surgical technique for inferior turbinate hypertrophy as it leads to less post-operative pain, reduced nasal crusting and earlier healing.

AbstractObjective:To assess success rates and symptom control after surgical treatment of nasal septal perforation.Method:A prospective study was undertaken of 28 consecutive patients with symptomatic nasal septal perforation treated surgically by one surgeon between 2005 and 2007. All patients underwent an open rhinoplasty approach with bilateral superior and inferior nasal mucosal advancement flaps and acellular porcine collagen placed in between. Symptom severity was assessed pre- and post-operatively using a validated visual analogue score. The nasal valve angle was assessed pre- and post-operatively by two independent assessors.Results:Patients comprised 12 women and 16 men, with a mean age of 45 years (range: 21–76). The mean follow up was 16 months (range: 6–24). The mean vertical and horizontal diameters of the perforations were 22 mm (range: 10–35) and 27 mm (range: 10–37), respectively. Twenty-seven (96 per cent) patients had complete closure of nasal septal perforation. There were statistically significant differences between the pre- and post-operative mean visual analogue scale scores for epistaxis (p < 0.001), crusting (p < 0.001), whistling (p < 0.001) and nasal obstruction (p < 0.001). Epistaxis, crusting and whistling resolved in all patients, and 92 per cent reported improvement in nasal blockage.Conclusion:Closure of nasal septal perforation using an open rhinoplasty approach with nasal mucosal advancement flaps and a porcine collagen sandwich is a pertinent and reliable technique for the management of nasal septal perforation.

Nasal septal perforations can cause issues of epistaxis, whistling, crusting, saddle deformity, and obstruction, which motivate patients to seek surgical repair. Numerous methods of septal perforation repair have been described, with surgical success rates ranging from 52% to 100%, but few studies address situations with concomitant septal deviation. In treating patients with septal perforation and deviation, both issues should be addressed for optimal outcomes. While routine septoplasty involves the removal of septal cartilage, septal perforation repair involves the addition of interposition grafts. The composite chondromucosal septal rotation flap harmoniously combines these seemingly conflicting goals as an effective and efficient technique for septal perforation repair. We present 3 patients successfully treated for their septal perforation and septal deviation concurrently with this technique.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Valgus deformity presents a major challenge in total knee replacement, especially in moderate or severe cases. Many surgical techniques have been described to balancethe soft tissues in correction of a severe valgus deformityduring total knee replacement. The structures most commonlyreleased in a valgus knee include the posterolateralaspect of the capsule, iliotibial band (IT band), the lateral collateral ligament (LCL), the popliteustendon, and the lateral head of the gastrocnemius muscle.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">thirty two patients undergoing unilateral total knee replacement were followed for the evaluation of study. There were 22 female (68%) and 10 males (32%) with an age of 62.7±6.9 years (range 50-75) with valgus deformity of 18.59˚±8.32˚ (range 10-40˚). Preoperative diagnosis was rheumatoid arthritis in 23 patients (72%) and osteoarthritis in 9 patients (28%). Posterior stabilizing cemented implants were used</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Based on total knee score we achieved 21 (63.64%) excellent, 10 (31.82%) good and 1 (4%) fair results. With the total functional score we had 16 (50%) excellent, 15 (45.45%) good and 1 (4%) fair results. In patients with only step1 release (17 patients) we achieved 84% (15 pts) excellent, 8% (1 pt) good, 8% (1 pt) fair with knee score; and 67% (11pts) excellent, 33% (6pts) good with functional score. In step 2 release group (15 pt) we achieved 10% (1 pt) excellent, 90% (14 pts) good with knee score; and 10% (1pt) excellent, 80% (13 pts) good and 10% (1 pt) fair with functional score. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Good to excellent results can be achieved with two step sequential lateral release of posterolateral capsule and IT band pie-crusting which has direct correlation with severity of valgus deformity. The safety, simplicity, and high success rate of the two step sequential lateral release of posterolateral capsule and pie-crusting of IT band justify its routine use to correct every valgus deformity in total knee replacement.</span></p>

The hypertrophy of inferior turbinates is considered one of the main causes of nasal obstruction. There are clinical and surgical options for treatment. If clinical control fails, the volumetric reduction of those structures is usually recommended. Theendoscopic approach is considered safe, as it enables a comprehensive assessment of the extent of the turbinate anatomy and effective hemostasis. Turbinoplasty is a procedure that requires manual skill and has the advantages of non-exposure of raw area, less chance of bleeding and less crusting. This study aimed to compare the postoperative outcome of patients who underwent inferior turbinoplasty under direct vision and via nasal endoscopy, through a prospective randomized study conducted at the IPO hospital (Instituto Paranaense de Otorrinolaringologia, Curitiba/PR, Brazil). In this study, 17 patients were evaluated and divided into two groups according to the surgical technique used. Both groups underwent flexible nasofibroscopy on the 15th and 30th day postoperatively, were asked if they experienced cacosmia, and if there was any need for nasal packing during the period. Although the video technique offers a broad view of the nasal anatomy and of the inferior turbinates, it demands more adequate material and more experience from the surgeon, and its surgical time is longer. By considering these results, we can conclude that there are no statistical differences between the postoperative results of the two turbinoplasty techniques.

Les pathologies du genou liées au sport sont nombreuses et impliquent, pour partie, la bandelette iliotibiale (ITT). Il s’agit d’un renforcement d’une partie du fascia profond de la cuisse, nommé fascia lata. Le fascia lata est un tissu conjonctif fibreux composé de fibres d’élastine et de réseaux de fibres de collagène présents dans différentes couches de tissu. Il a un rôle stabilisateur de l’articulation et permet le transfert des efforts entre les muscles, mais les propriétés et mécanismes de déformation de ce tissu restent mal connus. Dans ce contexte, les mécanismes de déformation du fascia lata lors de mouvements physiologiques du genou ont été étudiés. Des données quantitatives des champs de déformation du fascia lata ont été obtenues in situ mettant en évidence des mécanismes de déformation en traction, compression et aussi cisaillement. Par conséquent, le comportement mécanique d’échantillons isolés de fascia lata a été analysé avec des essais de cisaillement de type large bande et traction de biais, incluant l'étude de la cinématique des fibres de collagène. Une première contribution à la modélisation en éléments finis du comportement du fascia a également été proposée. Enfin, comme l'état de déformation naturel du fascia lata contribue à une bonne mobilité du genou, une étude in situ a été mise en place pour évaluer l'impact sur les déformations du fascia et mobilités articulaires d'une technique chirurgicale de relâchement des tensions, dite de pie-crusting appliquée à l’ITT et pouvant être recommandée dans des cas pathologiques. L’ensemble du travail réalisé apporte donc de nouveaux éléments dans l'étude du comportement mécanique du fascia lata
There are many sports-related knee injuries, some of which involve the iliotibial band (ITT). This is a thicker part of the deep fascia of the thigh, called fascia lata. The fascia lata is a fibrous connective tissue composed of elastin fibers and networks of collagen fibers present in different layers of tissue. It has a stabilizing role in the joint and allows the transfer of forces between muscles, but its properties and strain mechanisms remain poorly understood. In this context, the strain mechanisms of the fascia lata during physiological knee movements were studied. Quantitative data of fascia lata strain fields were obtained in situ highlighting strain mechanisms in tension, compression, and shear. Therefore, the mechanical behavior of isolated fascia lata samples was analyzed with shear tests such as bias extension tests and traction of a large band tissue. The study of collagen fiber kinematics was also included. A first contribution to the finite element modelling of fascia behavior was also proposed. Finally, as the natural state of deformation of the fascia lata contributes to good knee mobility, an in situ study was set up to evaluate the impact on joint mobility and strain levels on fascia of a surgical tension-release technique, known as pie-crusting, applied to the ITT and which may be recommended in pathological cases. All the work carried out therefore provides new elements in the study of the mechanical behavior of fascia lata