Sandwich graft technique outcomes in medium and large size nasal septal perforations / Resultados da técnica de enxerto sanduíche em perfurações do septo nasal de médio e grande porte

Abstract Introduction: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. Objective: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. Methods: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2cm, Group B: ≥ 2 cm). Results: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). Conclusion: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Resumo Introdução: O tratamento cirúrgico da perfuração do septo nasal de médio e grande porte ainda é um desafio. Várias técnicas são usadas, com e sem enxertos de interposição. Objetivo: Descrever o uso da técnica de enxerto sanduíche que usamos nas perfurações de septo nasal de médio e grande porte e apresentar os resultados. Método: Revisamos retrospectivamente os prontuários de pacientes que foram operados com a técnica de enxerto sanduíche entre janeiro de 2014 e dezembro de 2018, com acompanhamento por pelo menos seis meses. Os dados demográficos, escores de sintomas, exames e achados cirúrgicos dos pacientes foram extraídos dos registros hospitalares. Os resultados cirúrgicos foram apresentados de acordo com as etiologias (idiopática ou iatrogênica) e os tamanhos da perfuração (Grupo A: < 2cm, Grupo B: >2cm). Resultados: Revisamos 52 casos e 56 cirurgias. O diâmetro médio das perfurações foi de 19,2 mm. A taxa de sucesso após as cirurgias iniciais foi de 84,6% (44/52). Após quatro cirurgias de revisão, a perfuração foi fechada em 88,5% dos casos (46/52). As taxas de sucesso para os Grupos A e B foram, respectivamente, 90,0% e 86,4% (p = 0,689). As taxas de sucesso nos casos idiopáticos e iatrogênicos foram, respectivamente, 93,3% e 86,5% (p = 0,659). Conclusão: Este estudo mostrou que a taxa de sucesso da técnica de enxerto sanduíche foi maior nas perfurações de médio porte do que nas de grande porte e nas perfurações idiopáticas do que nas iatrogênicas, mas sem significância estatística. Esse dado demonstrou que o tamanho da perfuração não foi tão importante na técnica de enxerto sanduíche quanto nas técnicas com uso de retalho.

Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion

After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases.

Extracranial-Intracranial Bypass Surgery Using a Radial Artery Interposition Graft for Cerebrovascular Diseases

OBJECTIVE: To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. METHODS: The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. RESULTS: Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. CONCLUSION: EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

Clinical Outcome of Preoperative Portal Vein Thrombosis in Living Donor Liver Transplantation / 대한이식학회지

PURPOSE: Portal vein thrombosis (PVT), which once had been considered a relative contraindication for living donor liver transplantation (LDLT), is no longer contraindication of LDLT owing to technical achievement but could be remained as one of risk factor affecting patients. The aim of the present study was to improving outcomes of LDLT of patients with PVT by analyzing patients with PVT. METHODS: Between January 2000 and May 2006, 246 cases of LDLT in adult using right lobe were performed. The presence of PVT was preoperatively evaluated by CT and/or MR angiography. The patients were subdivided according to presence and characteristics of PVT; No PVT (n=196; 79.7%), Partial PVT (n=39; 15.9%) and Total PVT (n=11; 4.4%) and characteristics of each group were analyzed. RESULTS: Preoperatively, only the incidence of variceal bleeding was significantly higher in patients with PVT (P<05). Intraoperatively, larger amounts of transfused RBC were needed in PVT group and postoperatively, there were prolonged stay in ICU and higher incidence of hemorrhagic complications in PVT group. Portal inflow was reestablished by thrombectomy and end-to-end anastomosis without vessel graft in 97.4%(38/39) of partial PVT and in 54.5%(6/11) of total PVT. Cryopreserved veins were used as interposition (n=1) or jump (n=4) grafts and an autologous iliac vein was used as a jump graft (n=1). Of 5 cases of jump grafts, 2 cases were anastomosed to coronary vein, and 3 cases to superior mesenteric vein. The patency rate using vessel grafts was 83.3%(5/6) and overall patency rate including thrombectomy cases was 98.0%(39/40). CONCLUSION: Regardless of operative methods and materials, higher patency rate of portal vein could be achieved so that operation of patients with PVT could be undertaken safely without increased mortality.