Robotic Living Donor Right Hepatectomy: A Systematic Review and Meta-Analysis.

The introduction of robotics in living donor liver transplantation has been revolutionary. We aimed to examine the safety of robotic living donor right hepatectomy (RLDRH) compared to open (ODRH) and laparoscopic (LADRH) approaches. A systematic review was carried out in Medline and six additional databases following PRISMA guidelines. Data on morbidity, postoperative liver function, and pain in donors and recipients were extracted from studies comparing RLDRH, ODRH, and LADRH published up to September 2020; PROSPERO (CRD42020214313). Dichotomous variables were pooled as risk ratios and continuous variables as weighted mean differences. Four studies with a total of 517 patients were included. In living donors, the postoperative total bilirubin level (MD: −0.7 95%CI −1.0, −0.4), length of hospital stay (MD: −0.8 95%CI −1.4, −0.3), Clavien−Dindo complications I−II (RR: 0.5 95%CI 0.2, 0.9), and pain score at day > 3 (MD: −0.6 95%CI −1.6, 0.4) were lower following RLDRH compared to ODRH. Furthermore, the pain score at day > 3 (MD: −0.4 95%CI −0.8, −0.09) was lower after RLDRH when compared to LADRH. In recipients, the postoperative AST level was lower (MD: −0.5 95%CI −0.9, −0.1) following RLDRH compared to ODRH. Moreover, the length of stay (MD: −6.4 95%CI −11.3, −1.5) was lower after RLDRH when compared to LADRH. In summary, we identified low- to unclear-quality evidence that RLDRH seems to be safe and feasible for adult living donor liver transplantation compared to the conventional approaches. No postoperative deaths were reported.

An Unusual Case of Finger Fracture.

Enchondromas are commonly encountered primary bone tumors in the hand. They can be managed with various treatment options ranging from simple observation to curettage and bone grafting. In this study, the case of a finger enchondroma is reported; it presented as a pathological fracture. It was managed successfully using the delayed approach - initial stabilization of the fracture followed by definitive tumor clearance surgery. Concerning the early versus delayed approach used for fractures associated with enchondromas, there is an ongoing debate in the literature on whether to leave the cavity empty or fill it with bone graft after curettage. This article discusses the relevant literature on these issues and their impact on the refracture and rates of recurrence. Nevertheless, thorough curettage followed by regular monitoring in the follow-up period is important to minimize the morbidity associated with the recurrence of enchondromas.

A Curious Case of Ear Necrosis Salvaged by a Composite Temporalis Flap: Conchal Cartilage Graft Reconstruction.

Hemangiomas are commonly encountered benign vascular tumors in clinical practice. They are easily diagnosed clinically, but it is essential to know atypical and rare varieties of these tumors to avoid confusing them with vascular malformations. The traditional approach in managing hemangiomas has been a "wait and watch" policy as most of these lesions undergo spontaneous regression with time. There are multiple treatment modalities in managing these lesions, but with specific indications for each of them. We report a case of Nicolau syndrome following injection sclerotherapy for a residual ear hemangioma, which lead to necrosis and total loss of skin and cartilage. However, the full-thickness defect in the ear was restored with a composite temporalis fascial flap, conchal cartilage graft, and split skin graft reconstruction. A detailed literature review of the presentation and management of this vascular tumor is discussed with a special emphasis on avoiding complications and maximizing patient outcomes.

Epithelioid Sarcoma of Upper Extremity: Diagnostic Dilemma With Therapeutic Challenges.

Epithelioid sarcoma is a rare, slow-growing, malignant tumor with multivariate presentation and a high rate of recurrence following surgery. Diagnosis is often missed or delayed due to its infrequent nature and confusing clinical and pathological presentation. This is compounded by the fact that this tumor is aggressive with a propensity for metastases without being detected. The treatment of this deadly tumor is controversial with no clear-cut consensus. The author presents a case of epithelioid sarcoma in the finger of a young patient with subsequent recurrence after surgery and a review of current literature pertaining to this aggressive tumor. This report would like to stress the importance of a multimodal approach in combatting this tumor as prompt diagnosis and aggressive therapy can significantly reduce the poor outcomes associated with this disease.

Isolated Acquired Macrodactyly of the Left Fourth Toe.

Macrodactyly is a rare congenital disorder affecting the digits of hands and feet. It is often distressing for both parents and children. Surgical options range from soft tissue debulking with or without osteotomy and physeal arrest to simple or ray amputation. Although amputation is generally reserved for the severe progressive variant of macrodactyly and revision surgery, there is controversy regarding whether initial amputation or debulking is the best approach. We present a case of isolated macrodactyly of a minor toe, where debulking showed superior results.

Extravasation Injuries: A Trivial Injury Often Overlooked with Disastrous Consequences.

With the advent of parenteral, intravenous infusion for various purposes like chemotherapy, parenteral nutrition, radiocontrast intravenous injection for imaging studies, extravasation injuries are emerging as a serious problem with often disastrous complications, if not recognized early. Fortunately, if treated early, the affected extremities can be salvaged and hence the role of plastic surgeons cannot be over-emphasized, especially when it comes to the reconstruction of necrotic and ischemic wounds as a result of these injuries. Proper monitoring and immediate intervention will go a long way in minimizing the morbidity associated with these injuries. However, if there is a delay in recognition and treatment, it can lead to complications like skin necrosis, gangrene, extensive soft tissue defects and contractures. Treatment in these circumstances needs an individualized approach and entails wound debridement followed by skin grafts and flap cover. Documentation and prompt intervention can avoid medicolegal issues for the physician and the hospital.

Dorsal Metacarpal Artery Flap: An Underrated Workhorse Flap for Reconstruction of Dorsal Finger Defects.

The dorsal metacarpal artery (DMCA) flap is a versatile option in the armamentarium of the reconstructive hand surgeon, especially for resurfacing dorsal finger defects where the flap options are limited. The flap fulfills most of the reconstructive principles such as "to replace like with like" and is simple, reliable, and easy to harvest with minimal donor site morbidity. In this report, we discuss the case of a 37-year-old male patient who presented with a partially healed wound over the right middle finger. Several variations of the DMCA flap have been described in the literature, and these are briefly described here along with their applications and vascular basis.

Manejo multidisciplinario con drenaje interno endoscópico en fuga post manga gástrica / Multidisciplinary management with endoscopic internal drain of gastric sleeve leak

INTRODUCCIÓN. El número de pacientes con obesidad ha aumentado durante las tres últimas décadas. En el 2016 la manga gástrica ocupó el 53,6% de los procedimientos bariátricos a nivel mundial y la fístula gástrica es una complicación que tiene una prevalencia entre el 0,50 al 7,00%. CASO CLÍNICO. Paciente femenina de 46 años, con Índice de Masa Corporal de 45,20 kg/m 2, más dislipidemia y un exceso de peso de 54 kg al inicio del protocolo; presentó como complicación temprana fístula gástrica localizada en tercio superior con sepsis abdominal que necesitó cirugía de revisión con lavado más colocación de drenajes. RESULTADOS. Se realizó manejo con endoprótesis esofágica que migró por dos ocasiones, ameritó retiro, con posterior colocación de sonda nasoyeyunal más drenaje interno pigtail a través de la solución de continuidad. A los 39 días post cirugía de revisión egresó con cierre de fuga con Índice de Masa Corporal de 36 kg/m2 y parámetros nutricionales normales. DISCUSIÓN. La fístula o fuga post manga gástrica tienen cierre sin corrección quirúrgica que depende de las serie de hasta el 97,1%. El manejo endoscópico presentó resultados satisfactorios mediante el uso de catéter de drenaje interno "pigtail". CONCLUSIÓN. El manejo sistemático multidisciplinario para una fístula gástrica temprana con nutrición enteral mediante sonda nasoyeyunal más colocación endoscópica de drenaje interno "pigtail", fue una estrategia disponible para resolución de esta complicación, primer caso reportado en el país.

INTRODUCTION. The number of obese patients has increased over the past three decades. In 2016, gastric sleeve accounted for 53,6% of bariatric procedures worldwide, and gastric fistula is a complication with a prevalence of between 0,50 and 7,00%. CLINICAL CASE. 46-year-old female patient, with a Body Mass Index of 45,20 kg/m2, plus dyslipidemia and an excess weight of 54 kg at the beginning of the protocol; It presented as an early complication gastric fistula located in the upper third with abdominal sepsis that required revision surgery with lavage plus placement of drains. RESULTS. Management was carried out with an esophageal endoprosthesis that migrated twice, meriting removal, with subsequent placement of a nasojejunal tube plus internal pigtail drainage through the continuity solution. 39 days after revision surgery, he was discharged with leak closure with a Body Mass Index of 36 kg/m2 and normal nutritional parameters. DISCUSSION. The fistula or post gastric sleeve leak has closure without surgical correction that depends on the series of up to 97,1%. Endoscopic management presented satisfactory results using a pigtail internal drainage catheter. CONCLUSION. The systematic multidisciplinary management for an early gastric fistula with enteral nutrition through nasojejunal tube plus endoscopic placement of internal drainage "pigtail" was an available strategy for resolution of this complication, the first case reported in country.

Complex Irreducible Dorsal Dislocation of Thumb Interphalangeal Joint: Controversies and Consensus in Management.

Dislocations of thumb interphalangeal (IP) joint are rare injuries due to inherent stability of the joint. This report presents a case of complex irreducible dorsal IP joint dislocation of thumb due to interposition of four structures - volar plate, sesamoid bone, flexor pollicis longus tendon and digital nerve which is perhaps the only case reported so far in literature where more than three structures have been implicated for this joint irreducibility. The author presents a comparative review of similar case reports previously reported in literature listing the controversies in management and forming a broad consensus in the management of these difficult injuries. Finally, an algorithm for the management of these injures has been proposed in this article which maybe helpful for other operators in tackling these injuries so as to deliver predictable treatment outcomes.