Rhinoplasty Complications and Reoperations: Systematic Review

Abstract Introduction This article is related to complications of rhinoplasty and its main causes of reoperations. Objectives The objective of this study is to perform a systematic review of literature on complications in rhinoplasty. Data Synthesis The authors conducted a survey of articles related to key terms in the literature by using three important databases within 11 years, between January 2002 and January 2013. We found 1,271 abstracts and selected 49 articles to this review. Conclusion Themain results showed that the number of primary open rhinoplasty was 7902 (89%) and 765 closed (11%) and the percentage of reoperations in primary open complete rhinoplasties was 2.73% and closed complete was 1.56%. The statistical analysis revealed a value of p = 0.071. The standardization of terms can improve the quality of scientific publications about rhinoplasty. There is no difference between primary open or closed rhinoplasty techniques in relation to reoperations.

Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures / 대한정형외과학회잡지

PURPOSE: We evaluated the outcome of femoral stem revision for Vancouver B2 and B3 periprosthetic femoral fractures. MATERIALS AND METHODS: We conducted a retrospective assessment of 15 patients who had received treatment for a periprosthetic unstable femoral fracture after primary hip arthroplasty between May 1997 and September 2009. According to Vancouver classification, 11 patients were type B2 and four were B3. Open reduction and long stem revision were performed in all 15 cases. In Vancouver type B3 fractures, we treated patients with open reduction and long stem revision with an allogenic cancellous bone graft, which is the same as in that used in Vancouver type B2 fractures. An allogenic onlay cortical bone graft was used when additional stability was required. The mean age of patients was 67.1 years at the time of surgery and the mean duration of follow-up was 31.5 months. We described the clinical and radiographic results. RESULTS: Using Beals and Tower's criteria, fair to good clinical and radiologic results were observed at the latest follow up, with an average Harris hip score of 94.4 points. Fractures were united in all 15 patients. One patient had non-union of the greater trochanter of the femur, one patient had superficial infection, and one patient had non-union of onlay bone graft, however, there were no further complications, such as dislocations, periprosthetic infections, or nerve injuries. There was no loosening of the femoral stems. CONCLUSION: In Vancouver type B2 and B3 fractures, when there is loosening of the femoral stems, open reduction and long stem revision with allogenic cancellous bone graft provided a satisfactory result. However, long-term follow up is needed.

Delayed Electrode Extrusion after Cochlear Implant Repositioning / 대한이비인후과학회지

It is well known that cochlear implant device repositioned in the posterosuperior direction will cause intracochlear electrode extrusion. We have recently repositioned a cochlear implant device due to infection and device exposure. The device repositioning was performed under C-arm assisted fluoroscopic monitoring. The exposed device was covered with a local scalp flap. During and immediately after the repositioning operation, electrodes seemed to be well positioned in place. Mapping and neural response imaging were performed 4 days after the operation, and the results were quite similar to the preoperative results. But when the same tests were performed one month after repositioning operation, we found that the number 15 and 16 electrodes were not responsive. The transorbital view also revealed a slight extrusion of the intracochlear electrode. In the present article, we discuss the possible cause of delayed electrode extrusion and its clinical implication.

Treatment of Nasopharyngeal Stenosis after Revisional Palatopharyngoplasty with Balloon Dilatation and Topical Mitomycin-C Application / 대한이비인후과학회지

Nasopharyngeal stenosis (NPS) is a rare condition and classified as primary NPS (due to a disease process as syphilis) or secondary NPS (due to a surgery or radiotherapy) according to the etiology. Patients with NPS suffer significant morbidities, including nasal obstruction, phonatory changes, sleep disordered breathing, dysphagia, and otologic disturbances. Treatment modalities include wide range of strategies, such as local rotation flaps, free flaps, Z-plasty, prolonged stenting, insertion of obturators, and laser excision. However, treatment is difficult, often resulting in only short-term symptom relief and restenosis. The authors experienced a case of NPS following revisional palatopharyngoplasty in a 50-year-old man, which was treated successfully with balloon dilatation and topical mitomycin-C application. We present the etiology, symptoms, and treatment of this rare disease entity with a review of the literature.

Causes of Late Revision Surgery after Bone Cement Augmentation in Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: A retrospective study. PURPOSE: To elucidate the causes of late revision following bone cement augmentation for osteoporotic vertebral compression fractures (OVCFs). OVERVIEW OF LITERATURE: Percutaneous vertebroplasty (PVP) or kyphoplasty (KP) is thought to be effective for the treatment of OVCFs. Many complications related to PVP or KP have been reported. However, there is a paucity of reports regarding the causes of late revision surgery after failed PVP or KP. METHODS: Twenty six patients who developed unremitted back pain and/or progressive neurological deficit after a symptom-free period since treatment with PVP or KP were enrolled. All patients underwent cement removal and anterior reconstruction. Among the 26 patients, 22 patients underwent anterior interbody fusion combined with posterior instrumentation; 4 patients underwent anterior reconstruction only. The causes of revision surgery were assessed. Clinical results were assessed using a visual analogue scale (VAS) and Oswestry Disability Index (ODI). The complications were analyzed. RESULTS: The average time to revision surgery was 18.9+/-14.6 months (range, 3-78 months). The causes of late revision surgery included 6 late infections, 8 progressive kyphoses, 10 proximal fractures after instrumented lumbar fusions, and 2 late neurological involvement. During the mean follow-up period of 13.5+/-7.8 months, pre-revision mean VAS (8.5+/-0.9) and ODI (81.2+/-12.5) were improved to 4.2+/-1.4 and 54.8+/-17.6, respectively. Five patients (19%) had serious complications after revision surgery. CONCLUSIONS: This study presents complications of PVP or KP in the treatment of OVCFs although PVP or KP can be an effective treatment strategy for OVCF when applied in highly selected patients.

Biomechanical Evaluation of a Novel Posterior Integrated Clamp That Attaches to an Existing Posterior Instrumentation for Use in Thoracolumbar Revision

STUDY DESIGN: An in vitro biomechanical study. PURPOSE: To evaluate the biomechanics of a novel posterior integrated clamp (IC) that extends on an already implanted construct in comparison to single long continuous bilateral pedicle screw (BPS) and rod stabilization system. OVERVIEW OF LITERATURE: Revision surgery in the thoracolumbar spine often necessitates further instrumentation following a failed previous back surgery. Stability of these reconstructed constructs is not known. METHODS: Six osteoligamentous T12-L5 calf spines were tested on a spine motion simulator in the following configurations: intact, four level constructs (T13-L4), three level constructs (L1-L4), and two level constructs (L2-L4), by varying the ratio between BPS and IC. A load control protocol of 8 Nm moments was applied at a rate of 1degrees/sec to establish the range of motion value for each construct in flexion-extension, lateral bending, and axial rotation. Statistical analysis was performed on raw data using repeated measures analysis of variance and significance was set at p<0.05. RESULTS: On an average, the reduction in motion for the four level continuous pedicle screw and rod construct (67%) was similar to those extended with integrated clamps (64%). Furthermore, for three level and two level constructs, no significant difference was observed between continuous pedicle screw constructs and those revised with the integrated clamps (regardless of the ratio between BPS and IC). CONCLUSIONS: The novel posterior IC showed equivalent biomechanical rigidity to continuous pedicle screw rod constructs in revision scenarios. Clinical studies on posterior rod adjunct systems are necessary to confirm these results.

Staged Scar Revision of Angulated Facial Scar

Scar revision techniques are chief among the most important skills for facial plastic and reconstructive surgeons. In order to achieve the least amount of scarring following a surgical procedure, it is crucial that the surgeon always consider skin tension. In our hospital, staged scar revision was conducted on patients with angulated facial scars in order to reduce skin tension. We conducted a retrospective chart review of patients undergoing staged scar revision for angulated facial scars at our hospital from July 2002 to September 2010. The follow-up period was at least six months. All pre-and post-operative photographs were analyzed by two independent plastic surgeons. And the patients were asked to rate their overall satisfaction with their scar revision as very satisfied(5), satisfied(4), neutral(3), dissatisfied(2) or completely dissatisfied(1). Staged scar revision was used in 51 patients with angulated facial scars. Overall, a significantly improved scar and above(score > or =4), graded by an independent plastic surgerns, was notes in 47 patients(92.1%). And, 45 patients(88.2%) were satisfied with their scar revisions. In all cases, the postoperative clinical course was uneventful without any complications. In conclusion, staged scar revision is considered a good option for the treatment of angulated facial scar.

A Case of Revision Augmentation Rhinoplasty with Dermofat Graft: 2 Years Follow-up Result

Many allograft materials have been used for performing augmentation rhinoplasty. But in cases involving complications such as infection, inflammation and foreign body reaction, these should be removed and replaced with an autograft material which is more suitable for revision surgery. Frequently, the use of autograft materials, including bone and cartilage, are restricted by many limitations such as unavailability, insufficiency in volume, and resorption. By using the dermofat, however, we achieved good surgical results in revision rhinoplasty from the aspect of volume and donor site morbidity. Thus, we report this case with a review of the literature.

Analysis of Survival Rate and Cause of Revision in Penile Prosthesis: A Single Center Long Term Follow-up Study / 대한비뇨기과학회지

PURPOSE: There are many reports on penile prosthesis implantation, but few on the natural history of prosthesis. We investigated the failure rate and causes for revision. MATERIALS AND METHODS: We reviewed 518 cases of penile prosthesis implantation performed by the same surgeon from December, 1983 to March, 2005 at the department of urology in Yongdong Severance Hospital. The mean follow up duration was 92 months, and average age was 49.1 years. A penile prosthesis survival is defined as a prosthesis that does not need revision due to infection, mechanical dysfunction or dissatisfaction, and a patient who is able to have intercourse. Analysis was performed by Kaplan-Meier formula and Log rank test. Significance was defined as p below 0.05. RESULTS: The survival rate of AMS 600 was significantly higher than that of the inflatable prosthesis. The survival failure rate was 22.2% in the inflatable prosthesis. Mechanical failure was the most common cause of survival failure in the inflatable prosthesis. Especially, the cylinder survival rate was lower than that of the other compartment of AMS (American medical system) 700 CXM . The AMS 700 CXM survival rate was lower in the neurogenic erectile dysfunction than the other causes of erectile dysfunction. The survival rate was reliable in the original and revised cylinder. CONCLUSIONS: The overall survival failure rate was 16.4%. Neurogenic erectile dysfunction was the most prevalent risk factor of survival failure in AMS 700 CXM . The survival rate must be considered in neurogenic patients who want to be implanted with the inflatable prosthesis. The infection rate was not increased in AMS 700 CXM revision cases. However, further research is warranted for the development of a failure- free prosthesis.

Treatment of Arteriovenous Fistula Failure: Surgical Revision Versus Interventional Radiologic Procedure A prospective randomized study on secondary angioaccess procedure

There are over 10,000 individuals in Korea who require chronic hemodialysis treatment. Vascular access with an adequate blood flow and good long-term patency are important to have adequate dialysis. Thrombosis is the most common cause of angioaccess failure and is usually due to outflow stenosis. A thrombolysis using urokinase has been used frequently in recent years for treatment of a thrombosis, but its efficacy is not well documented in the literature. The authors report a prospective randomized study comparing a surgical revision versus a thrombolysis with and without luminal balloon angioplasty. The long-term patency and the total cost of treatment to the patient were compared.