Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation sur...Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision （V-Y plasty） in the first 35 males, was performed （Group A）, followed by circumcision ligamentolysis in the next 47 males （Group B）. The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years （range： 18-56 years）. Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises （length 〈7.5 cm）. The mean surgical times were 150.7 and 125.2 rain for Groups A and B, respectively （P=0.005）. Postoperatively, four Group A patients and three Group B patients （11% versus 6%, respectively） experienced penile retraction （P=0.453）. Hypertrophic scars were observed in 18 men （51%） in the former group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group （P=0.007 and 〈0.001, respectively）. With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.展开更多
BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options incl...BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.展开更多
Purpose: The treatment of intersphincteric and lowtranssphincteric fistula is well defined, but controversy remains around the management of complex perianal fistula. This study was designed to assess the utility of a...Purpose: The treatment of intersphincteric and lowtranssphincteric fistula is well defined, but controversy remains around the management of complex perianal fistula. This study was designed to assess the utility of anocutaneous flap repair in complex types of perianal fistula. Methods: Sixty-five perianal fistula in 65 patients treated with anocutaneous advancement flap for the complex fistula, between April 1998 and December 2002, are included this prospective study. Mean age was 34 ±2.1 (range, 24-53) years. Magnetic resonance imaging was used for the diagnosis of fistula. Excision of the internal opening and the overlying anoderm, curettage of the fistula tract, closure of internal opening with absorbable polyglactin 3/0 suture, and drainage of the external opening(s) by insertion of penrose drain were common operational steps. Outcome was evaluated in terms of healing and incontinence. Results: Successful healing of 59 of 65 complex fistulas was achieved using this technique with no disturbance of continence and minimal complications. Mean follow-up and complete healing time were 32 ±0.6 (range, 12-52) months and 5.4 ±0.8 (range, 3-7) weeks respectively. Conclusions: Although the study cases were relatively small in number, this report showed that clinical results of anocutaneous advancement flap are acceptable. However, large studies are needed to reach an ultimate conclusion for assessing the place of anocutaneous flap advancement in complex fistula.展开更多
文摘Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision （V-Y plasty） in the first 35 males, was performed （Group A）, followed by circumcision ligamentolysis in the next 47 males （Group B）. The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years （range： 18-56 years）. Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises （length 〈7.5 cm）. The mean surgical times were 150.7 and 125.2 rain for Groups A and B, respectively （P=0.005）. Postoperatively, four Group A patients and three Group B patients （11% versus 6%, respectively） experienced penile retraction （P=0.453）. Hypertrophic scars were observed in 18 men （51%） in the former group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group （P=0.007 and 〈0.001, respectively）. With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.
文摘BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.
文摘Purpose: The treatment of intersphincteric and lowtranssphincteric fistula is well defined, but controversy remains around the management of complex perianal fistula. This study was designed to assess the utility of anocutaneous flap repair in complex types of perianal fistula. Methods: Sixty-five perianal fistula in 65 patients treated with anocutaneous advancement flap for the complex fistula, between April 1998 and December 2002, are included this prospective study. Mean age was 34 ±2.1 (range, 24-53) years. Magnetic resonance imaging was used for the diagnosis of fistula. Excision of the internal opening and the overlying anoderm, curettage of the fistula tract, closure of internal opening with absorbable polyglactin 3/0 suture, and drainage of the external opening(s) by insertion of penrose drain were common operational steps. Outcome was evaluated in terms of healing and incontinence. Results: Successful healing of 59 of 65 complex fistulas was achieved using this technique with no disturbance of continence and minimal complications. Mean follow-up and complete healing time were 32 ±0.6 (range, 12-52) months and 5.4 ±0.8 (range, 3-7) weeks respectively. Conclusions: Although the study cases were relatively small in number, this report showed that clinical results of anocutaneous advancement flap are acceptable. However, large studies are needed to reach an ultimate conclusion for assessing the place of anocutaneous flap advancement in complex fistula.
