Abstract Objective: To evaluate the clinical application and efficacy of the endoscopic nasal "X"-like penetrating suture technique in septoplasty. Methods: A prospective randomized controlled trial was conducted on 40 patients diagnosed with nasal septum deviation by nasal endoscopy or paranasal sinus CT between May 2022 and May 2024. Patients were randomly allocated to two groups (20 cases each): the suture group received 5-0 absorbable X-shaped continuous trans-septal suturing without packing; the packing group received bilateral nasal expansion sponge packing. The primary outcome was postoperative subjective discomfort measured by visual analog scale (VAS, 0–10). Secondary outcomes included episodic nasal bleeding, length of hospital stay, and postoperative complications (adhesion, septal perforation, hematoma, hyposmia). All data were analyzed with SPSS 27.0 using independent-sample t-test and chi-square test; P<0.05 was considered statistically significant. Results: The mean VAS score for postoperative subjective discomfort in both groups was less than 4, significantly lower in the suture group compared to the packing group, with a statistically significant difference (p < 0.01). Conclusion: Endoscopic "X"-shaped penetrating suture reduces postoperative discomfort, shortens hospital stay, and does not increase complication risk versus packing. It is simple, feasible, and worth clinical promotion with careful patient selection for coagulopathy.
Abstract Objective: To explore of limb preservation outcomes and influencing factors in 100 cases of open limb fractures with vascular injuries using microsurgical repair. Methods: In this retrospective study, 100 cases of open limb fractures with associated vascular injuries, treated using microsurgical repair, were selected from January 2021 to January 2023 at our hospital. All patients were diagnosed with Gustilo type IIIC open fractures; detailed microsurgical repair techniques were performed according to different injury subtypes, including vascular anastomosis, fracture fixation, soft tissue coverage and decompression. The study aimed to evaluate treatment outcomes and analyze factors contributing to limb preservation failure. Results: The clinical data, including gender, age, cause of injury, fracture site, arterial injury, and time from injury to emergency treatment, were compared between patients who experienced limb preservation failure and those who achieved successful limb preservation (P>0.05). The time from injury to emergency treatment in patients with infection was (8.22±0.60) hours, significantly longer than in patients without infection (P<0.05). The fasting blood glucose (FBG) level in patients with infection was (6.12±0.67) mmol/L, markedly higher than in patients without infection (P<0.05). Clinical data, including gender, age, cause of injury, fracture site, and arterial injury, were compared between patients with and without infection (P>0.05). Conclusion: These findings supplement the existing literature by clarifying two critical modifiable factors (delayed treatment and elevated blood glucose) that affect infection and limb preservation, providing practical guidance for clinical practice to reduce infection risk and improve limb preservation rates.
Abstract Background: Osteosarcoma is the most common malignant primary neoplasm of bone. Amputation was the primary treatment modality for osteosarcoma before the advent of limb salvage. However, the limb salvage procedure for osteosarcoma in long bones presents challenges to orthopedists because of the large diaphyseal bone defect. Case presentation: A 13-year-old girl presented with a two-month history of mild pain in the distal diaphysis of her left femur. The physical examination at admission was recorded as follows: the local skin appeared normal, without redness or venous engorgement; there was an apparent tenderness in her left distal thigh, but no palpable mass. In our hospital, relevant examinations were performed. Computed tomography (CT) revealed that the soft tissue density can be seen in the medullary cavity. The adjacent cortex was involved. Magnetic resonance imaging (MRI) showed an irregular, abnormal signal measuring approximately 16cm × 4.2cm. Positron emission tomography-computed tomography (PET/CT) excluded the metastasis. The needle biopsy was also carried out, which confirmed an osteosarcoma. Accordingly, we performed an individualized treatment for this patient, which included the wide resection of osteosarcoma, secondary bone transport, and postoperative chemotherapy. During the five-year follow-up period, no local recurrence or distant metastasis occurred in the patient. Highlights: Large femoral bone defects are difficult to manage. A unifocal bone transport was successfully performed for the reconstruction of a massive bone defect of 18cm in an adolescent. Good outcome and function at 5 years of follow-up. Bone transport is a proper reconstructive technique. Conclusion: For the young patient with osteosarcoma, after the wide resection of the tumor, the use of distraction osteogenesis proves to be a remarkable option in reconstructing massive limb bone loss. The successful reconstruction in this case, with no local recurrence or distant metastasis during the five years of follow-up, demonstrates the effectiveness and potential of this technique.
Abstract Background: Intraoperative frozen section consultation serves as an essential tool for guiding optimal surgical management. This study investigated generational changes in the utilization of intraoperative frozen section over the past two decades in a tertiary healthcare center. Material and Methods: Pathology reports of patients who underwent intraoperative frozen section analysis at Kaohsiung Medical University Hospital between 2001 and 2020 were reviewed and categorized according to anatomic site. The number and distribution of intraoperative frozen section cases across various anatomic sites were analyzed over the past two decades. The proportions of frozen section for each anatomical site were compared between the periods 2001–2010 and 2011–2020. Result: In the first decade, 8,958 frozen sections were evaluated, accounting for 3.8% of all surgical specimens. Breast tissue constituted the most common specimen submitted for frozen section analysis, followed by tissues from the central nervous system and lungs. In the second decade, 12,156 frozen sections were obtained, accounting for 4.4% of all surgical specimens. Breast tissue remained the most frequently analyzed sample, followed by tissues from the lung and female genital system. Between the two decades, the proportion of frozen section significantly decreased for the thyroid, urinary tract, and soft tissue/bone. Conversely, the proportion significantly increased for specimens from the lung, oral cavity, female genital system, and skin. Conclusion: Regular evaluations are essential to prevent overuse and ensure adherence to current evidence-based practices. Further improvements in diagnostic accuracy, revision of practice guidelines, resource allocation, and adjustment of training programs are warranted.
Abstract Objective: To assess the combined effects of health insurance type and travel distance to the cancer center on outcomes after robotic-assisted pulmonary lobectomy for lung cancer. Summary of Background Data: Social determinants of health are predictors of surgical and cancer outcomes, but their intersectional effects have not been examined in lung cancer patients. Methods: We retrospectively analyzed 711 consecutive patients who underwent robotic-assisted pulmonary lobectomy (RAPL) from September 2010 to March 2022 by one surgeon. Patients were stratified by distance of primary residence ZIP code < or ≥ 160 kilometers from the cancer center and by public, private, or combination insurance type. Univariate analyses, multivariable logistic regression, and Cox regression survival analysis were performed. Results: Of our study patients, 514 patients lived <160 km of the cancer center (28.6% private, 20.4% public, 51.0% combination insurance) and 197 patients lived ≥160 km from the cancer center (26.9% private, 19.8% public, 53.3% combination insurance). Patients with combination insurance traveling <160 km had the highest average age (p <0.0001) and more comorbidities than any other group. Nonetheless, those with public insurance living ≥160 km from the cancer center had higher proportions of intraoperative and postoperative complications. Having public health insurance and traveling ≥160 km was the only combination that independently predicted worse 10-year overall survival in multivariable analysis ( p =0.0003). Conclusions: Higher travel burden and public health insurance type had a compounding disadvantage, highlighting the importance of an intersectional approach to understanding the social determinants of outcomes in surgical oncology.
