Mid‐face reshaping using threads with bidirectional convergent barbs: A retrospective study

BackgroundThe long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain, particularly in older adults, and may persist despite conservative treatment. Arthroscopic tenotomy is effective but requires an operating room, anaesthesia, and postoperative restrictions, which may be suboptimal in elderly or comorbid patients. Ultrasound-guided percutaneous LHBT tenotomy has emerged as a minimally invasive alternative, yet long-term clinical outcomes remain insufficiently reported. This study aimed to evaluate two-year pain, functional, and sleep-quality outcomes following ultrasound-guided percutaneous LHBT tenotomy in patients with isolated LHBT tendinopathy.MethodsThis retrospective case series included 51 consecutive patients (mean age 61.8 ± 4.8 years) with MRI-confirmed isolated LHBT tendinopathy who underwent ultrasound-guided percutaneous tenotomy between 2022 and 2024. Pain (VAS), functional scores (ASES and Constant–Murley), and sleep quality (PSQI) were assessed at baseline and at three, six, 12, and 24 months. Repeated-measures ANOVA or Friedman tests were used for longitudinal analysis, with effect sizes reported as partial eta-squared. Complications and patient satisfaction were recorded at the final follow-up.ResultsAll outcome measures improved significantly at each postoperative time point compared with baseline (p < 0.001). Mean VAS decreased from 6.84 ± 1.29 to 2.16 ± 0.89 at 24 months (η2 = 0.71), with 92.1% achieving the minimal clinically important difference (MCID). Functional outcomes improved markedly (ASES: 35.7 → 85.1; Constant–Murley: 60.4 → 82.5), both with large effect sizes (η2 = 0.68 and 0.64). PSQI improved from 9.2 ± 3.1 to 4.8 ± 2.2 (η2 = 0.56), reducing clinically significant sleep disturbance from 78.4% to 29.4%. Four patients (7.8%) developed asymptomatic Popeye deformity; no major complications occurred. Patient satisfaction at 24 months was 88.2%.ConclusionsUltrasound-guided percutaneous LHBT tenotomy is a safe, minimally invasive, and effective procedure that provides durable improvements in pain, function, and sleep quality over two years, with a low complication rate. It represents a valuable alternative to arthroscopic tenotomy in appropriately selected patients.

Retro-orbicularis oculi fat reduction via sub-brow incision in thyroid eye disease.

Push versus pull gastrostomy in cancer patients: A single center retrospective analysis of complications and technical success rates.

INTRODUCTION: Transcervical radiofrequency ablation (T-RFA) was FDA approved in 2021 and is an incision-free, uterine-sparing, minimally invasive treatment option for patients with uterine fibroids that achieves significant reductions in menstrual blood loss, fibroid volume, and increased health-related quality of life at 12 months. However, there is no data on perioperative outcomes when T-RFA is performed with a concomitant gynecologic procedure. OBJECTIVE: Our objective was to compare intraoperative and postoperative outcomes among patients undergoing T-RFA to those undergoing T-RFA with a concomitant procedure. METHODS: We conducted a retrospective cohort study of patients who underwent T-RFA between May 2024 and September 2025. Sociodemographic information, relevant health history, perioperative details, and postoperative outcomes were collected from electronic medical records. Exploratory analysis was performed to evaluate the following variables for T-RFA with or without a concomitant procedure: postoperative complications, postoperative infection, vaginal discharge, ED visit, readmission, postoperative complaint, IUD complaint, re-operation rate, OR time, EBL, PACU time, postoperative pain scores, and morphine milliequivalents (MME) required in PACU. RESULTS: Twenty-nine patients underwent T-RFA. The mean age was 44.7±6.8 years and the mean BMI was 32.8± 5.8 kg/m 2. Self-identified race was 48.3% Black, 34.5% White, and 17.2% Other. Fifteen patients (51.7%) had <5 fibroids, 14 (48.3%) had ≥5 fibroids, the mean fibroid size was 6.1 cm, and 16 (55.2%) had a fibroid >5 cm. One or more concomitant procedures were performed with T-RFA for 22 (75.9%) of patients, including dilation and curettage (69.0%), hysteroscopy (31.0%), hysteroscopic endomyometrial resection (24.1%), and levonorgestrel IUD insertion (20.7%). The groups were similar in baseline characteristics (Table 1). There were no statistically significant differences in postoperative infections, vaginal discharge, ED visits, readmission, postoperative complaints, or re-operation rate (Table 2). Additionally, there were no significant differences in OR time, EBL, PACU time, or MME in PACU between groups. While our small sample size introduces the possibility of type II error, the percentages reported in Table 2 suggest that the outcomes are unlikely to have clinically important differences despite our small cohort. A total of 6 patients underwent IUD insertion at the time of T-RFA. Of these, 3 (50%) had a malpositioned IUD and subsequently underwent IUD removal. While the sample size is small and we did not have an internal comparison group that underwent IUD insertion without concomitant RFA, our 50% malposition rate is significantly different from the ACOG published rate of 16.6% (p=0.028). CONCLUSIONS: In this cohort study, concomitant procedures performed at the time of T-RFA did not significantly impact most intraoperative or postoperative outcomes. These findings suggest that T-RFA may be performed in combination with other minor gynecologic procedures. However, a markedly elevated IUD malposition and subsequent removal rate of 50% was observed and raises concern about performing these with T-RFA. Despite our small sample size, patients should be counseled preoperatively, and delayed placement should be considered. Larger studies are needed to confirm these findings, evaluate safety, and guide patient counseling.Table 1Table 2

Double incision mastectomy with free nipple grafts (DIFNG) offers more flexible nipple-areola complex (NAC) resizing and repositioning in transmale and gender non-conforming individuals. The cis-male NAC has a smaller diameter, oval shape and lateral position. If nipple grafts are performed without having these considerations, aesthetics can be dissatisfying. We aim to describe the nipple split sharing technique during chest wall masculinization surgery comparing surgical, patient-reported outcomes (PRO) and aesthetic results with the conventional technique. This was a retrospective review of transmale patients who underwent DIFNG from January 2017 to January 2019. The cohort was divided into two groups: conventional and the splitting technique. Demographics, intraoperative and postoperative outcomes were recorded. In addition, PRO using Body-Q scale and aesthetic results using a Likert-based scale were analyzed. Thirty-four patients (68 breasts) underwent DIFNG. A total of 32 breasts underwent the split nipple reconstruction approach, whereas 36 underwent conventional technique. Median patient age and BMI in the nipple sharing and conventional technique groups were 27years and 35.4kg/m2, and 24years and 32.2kg/m2, respectively. Differences on postoperative complications were not statistically significant. Patient satisfaction on nipples' module was 90.7% vs. 58.1% in the nipple sharing vs. conventional technique, respectively (p < 0.05). The nipple's masculine aspect, size, contour, position and scars were aesthetically superior to the split approach (p < 0.05). Double incision mastectomy with nipple split sharing technique has good aesthetic outcomes, a low complication rate and high patient satisfaction. It is a great surgical alternative to improve aesthetics in chest wall masculinization surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Breast Surgery.

Aesthetic surgery of the thoracoabdominal region is one of the most frequently performed surgical procedures in plastic surgery. The combination of circumferential liposuction, autologous fat grafting of the buttocks and/or lower limbs, and the modified transverse abdominoplasty as an adjuvant procedure all done in a single surgical procedure is not very common. The authors present a prospective study of the surgical technique of composite body contouring, emphasizing the low rate of complications and the high overall patient satisfaction. A total of 64 consecutive female patients were operated on between January 2004 and January 2007. All the patients who were included in the study were candidates for a classical abdominoplasty. Posterior and lateral syringe-assisted liposuction combined with fat insertion into the buttocks and/or lower limbs was performed. Autologous fat grafting was done in the gluteal area for buttocks enhancement and in the lower limbs to correct contour deformities. Anterolateral liposuction with modified transverse abdominoplasty was done as an adjuvant procedure. Overall satisfaction with body appearance after composite body contouring was rated on a scale of 1-5. From 1,500 to 4,600 ml of fat was obtained with liposuction (mean = 2,478 ml). Forty-five patients had fat grafting only to the buttocks area. Six patients had fat insertion into the lower limbs and 13 had fat injection into the buttocks and lower limbs. The amount of fat transplanted to the buttocks varied from 165 to 625 ml (mean = 346 ml) and to the lower limbs it varied from 75 to 270 ml (mean = 195 ml). Three patients (5%) suffered from early complications, including infection (3%) and hematoma formation (2%). Nine patients (14%) had late complications, including hypertophic scars (7.5%), dog ears (4.5%), and localized fat excess (2%). Nine patients (14%) underwent revision surgery. Sixty-three percent reported that their appearance after composite body contouring was "very good" (42%) or "excellent" (21%) and 27% responded that their appearance was "good." Only 10% thought their appearance was less than good, (7% "fair" and 3% "poor").The average follow-up time has been 3.2 years (range = 2-5 years). Composite body contouring combines circumferential liposuction, fat grafting of the buttocks and lower limbs, and modified transverse abdominoplasty to accomplish very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction.

Introduction: Breast conserving surgery plus radiation therapy and mastectomy procedures has equal results in terms of survival. Oncoplastic surgery principles along with breast reduction techniques allow for very good aesthetic results in immediate breast reconstruction with local tissues in several well-defined clinical scenarios. Nevertheless, we still find several limitations to their use regarding the location of the tumor or the need for inconvenient skin resections out of the standard markings of breast reduction. We present a case where traditional breast reduction techniques were inadequate and technical modifications of standard markings and pedicle design were developed to avoid the need to undergo a mastectomy. Methods: We present a patient diagnosed with breast cancer where the clinical characteristics of the tumor (location, skin excision needed) precluded the use of traditional oncoplastic breast reduction techniques. Modifications to the traditional breast reduction techniques were used to cope with the oncological resections needed. Results: A good global symmetry and aesthetic result were achieved. Scar pattern obtained was considered relatively camouflaged and patient satisfaction was high. Conclusion: Breast reduction procedures can be the solution for the treatment of breast cancer. The location of the tumor in the superior quadrants outside standard markings and the need to include skin in the tumor resection can be sidetracked by using enlarged NAC pedicles with modifications to classic skin markings without compromising oncologic safety. The final aesthetic results obtained are considered very good and the patient is very satisfied.

Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017-2018: enrollment; 2018-2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications (p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade (p < 0.0001). Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.

Research Article| February 01 2014 Outcomes of Bariatric Surgery in Adolescents AAP Grand Rounds (2014) 31 (2): 18. https://doi.org/10.1542/gr.31-2-18 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outcomes of Bariatric Surgery in Adolescents. AAP Grand Rounds February 2014; 31 (2): 18. https://doi.org/10.1542/gr.31-2-18 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bariatric surgery Source: Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the teen-longitudinal assessment of bariatric surgery (Teen-LABS) study. JAMA Pediatr. 2014; 168(1): 47– 53; doi: https://doi.org/10.1001/jamapediatrics.2013.4296Google Scholar Investigators from multiple institutions prospectively enrolled a consecutive sample of patients <19 years old undergoing weight loss surgery (WLS) at one of 5 US academic referral centers. Although data collection was standardized, medical and surgical procedures varied across institutions. Preoperatively, investigators collected demographic and clinical data, including BMI, comorbid conditions, and laboratory measures relevant to cardiovascular risk and general health status. Investigators also collected data regarding the type of WLS performed and the occurrence of perioperative (time of surgery to hospital discharge) and postoperative (time of discharge to 30 days postdischarge) complications. The major goals of this study were to evaluate the clinical characteristics of adolescents undergoing WLS and to assess the short-term safety of the procedure in this population by measuring major perioperative and postoperative complications. A major perioperative complication was defined as an adverse event that was life-threatening or resulted in death, had potential for permanent harm, resulted in organ loss, led to reoperation or blood transfusion, or represented a deviation in anesthetic or surgical management. Major postoperative complications included those that were life-threatening or resulted in death, had potential for permanent harm, or required abdominal reoperation. Of 277 eligible patients, 242 were enrolled. The mean age of participants was 17.1 years (range 13–19); 72% were white and 76% were female. The median BMI was 50.5. Overall, 49% of study participants had ≤3 comorbidities, 39% had 4 to 5 comorbidities, and 12% had 6 or more. The most common comorbidities were dyslipidemia (74%), sleep apnea (57%), joint pain (46%), hypertension (45%), and back pain (45%). The most common preoperative laboratory abnormalities included elevated C-reactive protein (75%), hyperinsulinemia (71%), low high-density lipoprotein (64%), and hypertriglyceridemia (40%). Microalbuminuria was detected in 18% of patients. Most participants (67%) had a Roux-en-Y gastric bypass (RYGB). The remainder either had a vertical sleeve gastrectomy (28%) or adjustable gastric banding (5%). All procedures were laparoscopic; only 1 required conversion to an open laparotomy. There were 19 participants (7.9%) who experienced 20 major complications perioperatively and 7 participants (2.9%) who experienced 7 major complications postoperatively. Major perioperative complications included splenectomy secondary to intraoperative splenic injury (n = 1) and early reoperation for intestinal obstruction, bleeding, or gastrointestinal leak (n = 7). Major postoperative complications included pulmonary embolus (n = 2) and reoperation secondary to gastrointestinal leak (n = 2). There were no deaths. Procedure-specific rates of patients with major complications were highest with RYGB both peri- and postoperatively. The authors conclude that WLS in obese adolescents has a low rate of major perioperative and postoperative complications. Dr Snyder has disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This is a well-planned and well-executed study... You do not currently have access to this content.

Background and Objectives: Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure’s outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion. Materials and Methods: This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA® Intragastric Balloon System. Patients’ records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded. Results: The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis. Conclusions: IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results.

Arthroscopic subscapularis repair using the subscapularis interlocking (SICK)-stitch technique leads to restoration of clinical function with low complication and revision rates

1127 MAJOR COMPLICATIONS OF ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY SIGNIFICANTLY DECREASE AFTER 100 CASES

Although vaginal reconstructions with intestinal segments require particularly complex surgical procedures, this technique has become popular with respect to fairly good functional and esthetic outcomes. This study describes cases of vaginal reconstruction performed using a modified rectosigmoid colon held in an ischemic state in order to reduce secretion and denervated in order to prevent defecation problems. Vaginal reconstructions with rectosigmoid colon were performed on 43 patients. In this retrospective study, 34 patients had Müllerian agenesis, while nine had undergone male to female sex reassignment surgery in which adequate vaginal depth had not been achieved. A rectosigmoid colon with its vascular pedicle was used and left in an ischemic state. All nerve structures within the pedicle were excised intraoperatively. Follow-up period was between 12 and 60 months. Partial necrosis occurred in one patient which was reconstructed with local flap. Hematoma developed beneath the skin incision in two cases, but resolved with conservative treatment. A good esthetic outcome was achieved in all cases. Sexual function was assessed using the Female Sexual Function Index (FSFI) in 15 patients. Fourteen out of 15 patients scored above 26.5 on this scale and were determined as having no sexual dysfunction (FSFI score ≥26.5). In conclusion, vaginal reconstruction with denervated rectosigmoid held in an ischemic state appears to be a reasonable option among several available reconstruction techniques.

Objective: The aim of this study was to evaluate success and complication rates of percutaneous radiological gastrostomy (PRG). Method: The patients who had PRG in our interventional radiology unit between June 2012 and December 2018 were included in the study. Patients’ procedure reports and images were evaluated retrospectively. Patients’ age, gender, diagnosis, technical success and rate of complications of the procedure were the research parameters. Results: A total of 23 patients were referred for PRG. (mean age 63.1 years range: 20-90 years) Indications for PRG were head- neck cancer, other cancers, stroke and other neurologic disorders in 9 (39.2%), 6 (26.1%), 5 (21.7%) and 3 (13%) patients, respectively. 4 patients had replacement with a new gastrostomy catheter and 19 patients had PRG for the first time. In the present study technical success rate was 100%. In 5 patients minor complications were occured in 30-day follow up (21.7%). 3 patient died due to other comorbidities. There were no major complications. Conclusions: PRG is a practical and safe procedure with a high success and low complication rates in patients with a need of enteral feeding.

IntroductionCardiac implantable electronic devices (CIED) are associated with low rates of procedure-related complications but many of these complications are associated with significant morbidity and prolonged hospitalisations. The aim of this...