Work-Related Musculoskeletal Discomfort and Injury in Microsurgeons

J reconstr Microsurg
DOI: 10.1055/s-0038-1675177

Background Long surgical procedures with loupe magnification and microscopes may put microsurgeons at an increased risk of musculoskeletal discomfort. Identifying the prevalence and impact of work-related musculoskeletal discomfort may guide preventive strategies to prolong well-being, job satisfaction, and career duration. Methods An online 29-question survey was designed to evaluate work-related musculoskeletal discomfort. The survey was created and distributed electronically through a private survey research center and was sent to the members of the American Society for Reconstructive Microsurgery. Results There were 117 respondents (16.7% response rate): 80% were men; 69% were aged 31 to 50 years; and 68% were in academic practice. On a scale of 0 to 10 (0, no pain and 10, worst pain), the median for work-related musculoskeletal discomfort for surgery without loupes or microscope was 2; with loupes, 4; and with a microscope, 5. Pain was most common in the neck. Half of the surgeons reported pain within 4 hours of surgery, and 57% feared that pain would influence future surgical performance. Surgeon discomfort affected posture (72%), stamina (36%), sleep (29%), relationships (25%), concentration (22%), and surgical speed (19%). Tremor caused by the discomfort occurred in 8%. Medical treatment for discomfort was sought by 29%. Time off work for treatment occurred for 8%. Conclusion Work-related musculoskeletal discomfort can affect many aspects of a microsurgeon's life and has the potential to limit a surgeon's ability to operate. Therefore, more emphasis is needed in the surgical community on the important issues of occupational health and surgical ergonomics for microsurgeons.
[...]

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Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

J reconstr Microsurg
DOI: 10.1055/s-0038-1675146

Background Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. Methods A single-center retrospective study including long-term follow-up was approved by the local ethics committee. From January 1999 to December 2010, a total of 581 free flaps were performed for lower extremity reconstruction. Eighty-six flaps required emergency re-exploration, of which 65 could be salvaged. Fifteen salvaged flaps were excluded from the study because of secondary amputation. Of 50 patients, 29 (6 females and 23 males) were eligible for follow-up. The mean follow-up time was 54.5 ± 32.9 months. Health-related quality of life (Short Form 36 [SF-36]) and scar quality (Vancouver Scar Scale [VSS]) were analyzed. Results The overall flap survival rate was 94.7% and the total loss rate was 5.3%. The re-exploration rate was 14.8% (86 of 581 flaps). The salvage rate was 75.6% (65 of 86 flaps). Twenty-one free flaps were totally lost (24.4%). Partial flap loss occurred in 12 cases (14.0%); 67.5% of the vascular complications occurred during the first 24 hours, 20.9% between 24 and 72 hours, and 11.6% after more than 72 hours. The mean time from the first signs of impaired flap perfusion to re-exploration was 1.3 ± 0.4 hours, and from free tissue transfer to re-exploration was 16.2 ± 1.9 hours. The overall scar appearance was good with an average VSS score of 4.0 points. The average SF-36 physical component score was 54.4 ± 5.4 and the mental component score was 63.1 ± 10.7. Conclusion Careful monitoring and the opportunity for urgent re-exploration are the key to success for free flaps salvage. Following these principles, an acceptable long-term outcome can be achieved.
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Lower Extremity Free Tissue Transfer in the Setting of Thrombophilia: Analysis of Perioperative Anticoagulation Protocols and Predictors of Flap Failure

J reconstr Microsurg
DOI: 10.1055/s-0038-1675145

Aim No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. Methods Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon. Patients were divided into two cohorts based on the introduction of a novel, risk-stratified algorithm for perioperative anticoagulation in July 2015. Demographic data, chemoprophylaxis profiles, flap outcomes, and complications were retrospectively compared across time periods. Results Fifty-seven free flaps were performed in hypercoagulable patients treated with non-stratified (n = 27) or risk-stratified (n = 30) thromboprophylaxis. Patients in the risk-stratified cohort received intravenous heparin more often than non-stratified controls (73 vs. 15%, p < 0.001). Lower rates of total (3 vs. 19%, p = 0.06) and partial (10 vs. 37%, p = 0.025) flap loss were observed among risk-stratified patients, paralleling a significant reduction in the prevalence of postoperative thrombotic events (1.2 vs. 12.3%, p = 0.004). While therapeutic versus low-dose heparin infusion was associated with improved flap survival following intraoperative microvascular compromise (86 vs. 25%, p = 0.04), salvage rates in the setting of postoperative thrombosis remained 0%, regardless of protocol. On multivariate analysis, recipient-vessel calcification (odds ratio [OR]: 16.7, p = 0.02) and anastomotic revision (OR, 3.3; p = 0.04) were independently associated with total flap failure. Conclusions Selective therapeutic anticoagulation may improve microsurgical outcomes in high-risk patients with thrombophilia. Our findings highlight the importance of meticulous technique and recipient-vessel selection as critical determinants of flap success in this population.
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Evaluation of the Extent of Vessel Avulsion Injury: An Experimental Study Using a Rabbit Model

J reconstr Microsurg
DOI: 10.1055/s-0038-1675178

Background Determining the extent of damage in vascular avulsion type injuries still represents a challenge for the microsurgeon. Excision of the damaged section is critical for the success of anastomosis. The purpose of this study was to determine which among vascular endothelial and adventitia damage findings is most effective in determining the extent of avulsion injury. Methods Varying degrees of avulsion were applied to the aorta of 12 (n = 12) adult female New Zealand rabbits. Avulsion was first determined using adventitial findings and then with endothelial findings. The definitive extent of damage was determined histopathologically. Results The mean area of the histopathological sections was 16.7 ± 6.9 mm. The extent of damage measured from the adventitia was 15.8 ± 7.9 mm (the difference in histopathological examinations was not significant, p = 0.590, paired t-test), while the extent of damage from the lumen was 13.3 ± 8.2 mm (the difference in histopathological examinations was significant p = 0.004, paired t-test). Conclusion Excision based on adventitia findings is more effective in case of avulsion injury.
[...]

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Correction to: Cytokine release kinetics of concentrated growth factors in different scaffolds

Legend of fig. 1a and b was reversed in the original version of this article.

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In vivo and in vitro assessment of the bleaching effectiveness of a brush-off patch containing 3.0% hydrogen peroxide

Abstract

Objectives

To evaluate the efficacy of a brush-off patch containing 3.0% hydrogen peroxide, which is a new over-the-counter (OTC) product for tooth whitening, and determine the optimal protocol for use.

Materials and methods

We performed an in vitro study using hydroxyapatite specimens and a clinical trial involving 140 volunteers. The brush-off patch was applied to the specimens (in vitro) or the maxillary anterior teeth (in vivo; 14 days) for 10 min twice daily (case 10 group) or 30 min once daily (case 30 group). We also included control groups in both experiments. Lightness (L*), redness (a*), and yellowness (b*) values were measured using a colorimeter. In the in vivo study, color changes were measured at baseline and 7 and 14 days after the start of patch application. The overall color change (ΔE) was statistically analyzed.

Results

In the in vitro study, the color change (ΔE*) after the experiment was significantly different between the two case groups and the control group (p < 0.001). In the in vivo study, the case groups showed color changes at both 7 and 14 days after patch application. In particular, the change in the case 30 group was significantly more prominent on day 14 than on day 7 (p < 0.05).

Conclusion

Our findings suggest that brush-off patches containing 3.0% hydrogen peroxide are effective OTC products for tooth whitening.

Clinical relevance

For best results, brush-off patches containing 3.0% hydrogen peroxide can be applied once daily for 30 min.

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A Prospective Randomized Blinded Trial Comparing Digital Simulation to Textbook for Cleft Surgery Education

Background: Simulation is progressively being integrated into surgical training, yet its utility in plastic surgery has not been well described. We present a prospective, randomized, blinded trial comparing digital simulation to a surgical textbook for conceptualization of cleft-lip repair. Methods: Thirty-five medical students were randomized to learning cleft repair using a simulator or textbook. Participants outlined markings for a standard cleft-lip repair before (pre-intervention) and after (post-intervention) 20 minutes of studying their respective resource. Two expert reviewers blindly graded markings according to a 10-point scale, on two separate occasions. Intra-rater and inter-rater reliability were calculated using intra-class correlation coefficients. Paired and independent t-tests were performed to compare scoring between study groups. A validated student satisfaction survey was administered to assess the two resources separately. Results: Intra-rater grading reliability was excellent among both raters for pre-intervention and post-intervention grading (rater 1 ICC=0.94 and 0.95, respectively; rater 2 ICC=0.60 and 0.92, respectively; p

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“Flap Preconditioning with the Cyclic Mode (Triangular Waveform) of Pressure-Controlled Cupping in a Rat Model: An Alternative Mode to the Continuous System”

Background: Improving flap survival is essential for successful soft-tissue reconstruction. Although many methods have been attempted to increase the survival of the distal flap portion, there has been no widely adopted procedure. We evaluated the effect of flap preconditioning with two different modes (continuous and cyclic) of external volume expansion (pressure-controlled cupping) in a rat dorsal flap model. Methods: Thirty rats were randomly assigned to the control group and two experimental groups (n=10/group). The continuous group underwent 30 min of preconditioning with -25 mmHg pressure once daily for 5 days. The cyclic group received 0 to -25 mmHg pressure for 30 min with the cyclic mode once daily for 5 days. On the day after the final preconditioning, caudally based 2x8-cm dorsal random-pattern flaps were raised and replaced in the native position. On postoperative day 9, the surviving flap area was evaluated. Results: The cyclic group showed the highest flap survival rate (76.02%), followed by the continuous and control groups (64.96% and 51.53%, respectively). All inter-group differences were statistically significant. Tissue perfusion of the entire flap showed similar results (cyclic, 87.13%; continuous, 66.64%; control, 49.32%). Histologic analysis with hematoxylin and eosin, Masson trichrome, and CD31 staining showed the most increased and organized collagen production with hypertrophy of the attached muscle and vascular density in the cyclic group, followed by the continuous and control groups. Conclusions: Flap preconditioning with the cyclic mode of external volume expansion is more effective than the continuous mode in an experimental rat model. Further studies will be necessary for clinical application. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript Authors' Contributions: K.S.K. came up with the main idea and its concept of hypothesis in this experiment. He led the process of this study. Y.G.H. mainly conducted the animal experiment and further organized and analyzed histologic results. He wrote the article. S.C.K. supervised and advised the experimental process and participated in the laboratory meeting with the team and gave several opinions during discussion. Ethics Statement: All procedures were conducted in accordance with the Guide for the Care and Use of Laboratory Animals of the Asan Life Science Research Center animal review board (document no. 2017-13-113). Corresponding author: Kyung S. Koh, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul 05505, Korea. Tel.: +82-2-3010-3600, Fax: +2-476-7471, E-mail: kskoh@amc.seoul.kr, kyungskoh@gmail.com ©2018American Society of Plastic Surgeons

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Outcomes of Elbow Flexion Reconstruction in Patients Over 50 with Traumatic Brachial Plexus Injury

Background: There is controversy regarding the effectiveness of brachial plexus (BP) reconstruction for elbow function in older patients as reported outcomes are generally poor. The purpose of this study is to evaluate elbow function outcomes in patients over 50. Methods: Fifty-eight patients over the age of 50 underwent nerve grafting, transfers or free functioning muscle transfer (FFMT) to improve elbow function after traumatic BP injury. Patients were evaluated pre- and post-operatively for elbow flexion strength and range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH) scores, pain, delay from injury to operation, concomitant trauma, severity of trauma, and type of reconstruction. Results: The average age was 57.8 years (range 50-72) with an average follow-up of 24.0 months. The average modified BMRC (British Medical Research Council) elbow flexion grade improved significantly from 0.26 to 2.63. Thirty-three patients (60%) achieved functional flexion ≥M3 post-operatively, compared to zero patients pre-operatively. There was no correlation between age and modified BMRC grade. Active elbow ROM improved significantly post-operatively, with no effect of age on flexion motion. More patients achieved ≥M3 flexion with nerve transfers (69%) compared to FFMT (43%). Patients had worse outcomes with high energy injuries. The mean DASH score decreased from 51.5 to 49.6 post-operatively and the average pain score decreased from 5.0 to 4.3. Conclusion: BP reconstruction for elbow function in patients over the age of 50 can yield useful flexion. Conflicts of Interest: We have no conflicts of interest or financial interest to disclose. Corresponding author: Alexander Shin, MD, shin.alexander@mayo.edu, Division of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, 55905 Rochester, MN ©2018American Society of Plastic Surgeons

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Wide-awake flexor pollicis longus tendon reconstruction with evaluation of the active voluntary contraction of the ruptured muscle-tendon

Background: The purpose of this study was to investigate the clinical outcome of the wide-awake tendon reconstruction for chronic rupture of the flexor pollicis longus (FPL) tendon with evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit. Methods: Eleven consecutive patients underwent tendon reconstruction under wide-awake surgery for chronic tendon rupture of the FPL. If the total of the passive distraction distance (PDD) and the ACD of the ruptured FPL musculotendinous unit was greater than 30 mm, tendon grafting was performed. If not, tendon transfer was performed using the 4th flexor digitorum superficialis (FDS). Patients were evaluated with total active motion (TAM) before surgery, during surgery, and in final follow-up and subjectively surveyed with quick Disability of the Arm, Shoulder, and Hand (q-DASH) scores. The final outcomes of tendon grafting and of tendon transfer were compared. Results: Tendon grafting was performed in 4 patients, and tendon transfer was performed in 7 patients while maintaining finger active motion during surgery. The final follow-up %TAM was 84.3%±12.7% in the tendon transfer group and 80.7%±10.2% in the tendon grafting group. There were no significant differences between tendon transfer and tendon grafting in the final follow-up %TAM and q-DASH scores. Conclusions: The functional outcomes of both tendon grafting and tendon transfer were acceptable based on evaluating the ACD and PDD of the ruptured musculotendinous unit during wide-awake surgery. Evaluating the ACD and PDD may be a useful index to assess the ruptured musculotendinous unit. The greatest advantage of the wide-awake tendon reconstruction is that surgeons can evaluate the ruptured musculotendinous unit and measure TAM during surgery while adjusting suture tension. Financial Disclosure: none Acknowledgements: none This report was approved by the Ethics Comitee, University of Toyama (Toyama, Japan) and clinical reaserch number "21-22" was granted. Corresponding auther: Mineyuki Zukawa. MD ©2018American Society of Plastic Surgeons

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“Delayed Post-conditioning with External Volume Expansion (EVE) Improves Survival of Adipose Tissue Grafts in a Murine Model”

Background: External volume expansion (EVE) improves the survival of adipose tissue grafts by pre-operatively conditioning ('pre-conditioning') tissues that will receive the graft. EVE's mechanisms of action (induction of angiogenesis and of adipogenesis) could improve graft survival also when applied post-operatively (post-conditioning). We tested this hypothesis and optimized the parameters of post-operative application of EVE in a murine model. Methods: Fifty-six 8-week-old athymic (nu/nu) mice received dorsal subcutaneous grafts of human lipoaspirate (0.3 ml each) bilaterally before undergoing EVE (left dorsum) or no treatment (right dorsum, controls). EVE was started either on the same day of (Immediate group), two days after (Early group), or one week after surgery (Delayed group). At follow-up, grafts were analyzed for tissue survival, remodeling, adipogenesis, and angiogenesis using histology. Volume retention was assessed by MRI. We subsequently assessed the effects of the Delayed application of EVE adopting a foam-shaped interface (F-EVE) to deliver the treatment. Results: At 28 days follow-up delayed post-conditioning with EVE significantly improved the survival of grafts (+18%) compared to controls (viable graft thickness ratio: 58 ±15% vs 49 ±13%) and increased the density of blood vessels within the graft (+63%: blood vessels/ 10x magnification field: 44 ±12 vs 27 ±11). Other groups did not lead to significant changes. Adoption of F-EVE similarly improved outcomes while further reducing fibrosis within the grafts. Conclusions: Post-operative delayed application of EVE modestly improves the survival of adipose tissue grafts by inducing adipogenesis and angiogenesis. Use of a foam-shaped interface decreases the fibrosis induced in the grafts. # co-first authors Acknowledgments, conflict of interest and role of funding sources disclosure statement: Dr. Orgill receives research funding through grants from Acelity L.P. to Brigham and Women's Hospital and is a consultant for Acelity L.P. All other authors declare no actual or potential conflict of interests: in addition, they disclose no commercial or financial associations, personal or other relationships with other people or organizations that could inappropriately influence the reported manuscript or create a conflict of interest with the information presented. This study was funded by a research grant from Acelity L.P. Inc. to Brigham and Women's Hospital and a research grant by the Gillian Reny Stepping Strong Foundation to Brigham and Women's Hospital. Authorship: All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have seen and agreed to the submitted version of the manuscript and bear responsibility for it. Ethics: The study was carried out under high ethical standards. All the studies have been approved, when required, by the appropriate ethics committee and have been performed in accordance and in conformity to the World Medical Association Declaration of Helsinki (June 1964) and subsequent amendments. Meetings at which the paper has been presented: None. Corresponding authors: Dennis P. Orgill (* corresponding author), Tissue Engineering and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, 75 Francis St., Boston MA 02115 (USA). T: 617-732-5456F: 617-730-2855E:dorgill@partners.org ©2018American Society of Plastic Surgeons

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“Craniometric Analysis of Endoscopic Suturectomy for Bilateral Coronal Craniosynostosis.”

Background: Endoscopic suturectomy and helmeting represents a successful first-line surgical treatment for bilateral coronal craniosynostosis. Its effect on cranial morphology has not been previously described. Methods: Patients were identified who had bilateral coronal craniosynostosis treated with endoscopic suturectomy and postoperative helmeting at Boston Children's Hospital between 2005 and 2013 and who received pre- and post-operative CT scans. Two normative patient populations were identified from our trauma registry with CT scans completed at the same age as our pre- and post-treatment scans. Craniometric indices were utilized to quantify the effect of treatment. Results: Twenty-seven patients were identified who underwent bilateral coronal suturectomy. Twelve patients had preoperative and postoperative CT studies. Eight patients (66.7%) were syndromic. The average ages for preoperative and postoperative CT scan was 1.1 months (0.03–2.6) and 19.6 months (10.8–37.5). Thirteen patients with an average age of 1.1 months (0.5–1.6) were identified as a preoperative control group. Fourteen patients with an average age of 18.5 months (15.5–22.9) were identified as a postoperative control group. The anterior cranial height (ACH) stabilized with treatment and the anterior cranial base length increased (ACBL). The ACH:ACBL ratio significantly decreased with treatment (p=0.128). Frontal bossing normalized with endoscopic suturectomy (CS vs control; pre-op: p=0.001, post-op (p=0.8). Cephalic indices also normalized with treatment (CS vs control; pre-op: p=0.02, post-op, p=0.13). No cases of hydrocephalus were observed. Conclusion: Endoscopic suturectomy and helmeting improves anterior turricephaly and corrects frontal bossing and brachycephaly in patients with bilateral coronal craniosynostosis. FD - None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: S. Alex Rottgers MD, Assistant Professor of Plastic Reconstructive Surgery, John Hopkins All Children's Hospital, Division of Plastic and Reconstructive Surgery, 601 Fifth Street South, Suite 306, St. Petersburg, FL. srottge1@jhmi.edu ©2018American Society of Plastic Surgeons

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Evaluation of Donor Morbidity Following Single-Stage Latissimus Dorsi Neuromuscular Transfer for Facial Reanimation

Background: Single-stage latissimus dorsi (LD) neuromuscular transfer has been a valuable option for dynamic smile reanimation. However, there is a paucity of studies evaluating the potential donor morbidity in such cases. The present study aimed to comprehensively analyze the donor morbidity following functional LD muscle transfer. Methods: Patients who underwent single-stage functional LD muscle transfer for smile reanimation between 2002 and 2016 were reviewed. Postoperative complications and functional impairments at the donor sites were evaluated. The Quick-Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used for assessing postoperative donor-site function. Results: Sixty patients including 12 pediatric (≤ 18 years) were analyzed. Mean length of a harvested thoracodorsal nerve was 14.9 cm. Fourteen patients were treated with dual innervation technique, in which both a descending and transverse branch of the thoracodorsal nerve were harvested. Donor complications were observed in seven cases; all of them were seroma and resolved by simple aspiration. No other complications including scoliosis and sensory and/or motor disturbances in the upper extremities were encountered. Fifty patients responded to the Quick-DASH questionnaire at a median follow-up period of 51 months. The average score was 2.64 and all but three patients scored less than 10. No variables, including patient age (pediatric versus adult) and the use of dual innervation technique, affected the donor morbidities including the functional deficits. Conclusions: Single-stage LD neuromuscular transfer for facial reanimation might be associated with a low rate of complications and minimal functional morbidity at the donor site. Financial Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at:13thInternational Facial Nerve Symposium, August 3-6, 2017, Los Angeles, CA (Podium) Corresponding Author Contact Information: Dr. Goo-Hyun Mun, MD, Ph D., Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, S. Korea. 135-710.,Tel.: 82-2-3410-2233, Fax: 82-2-3410-0036, E-mail: supramicro@gmail.com ©2018American Society of Plastic Surgeons

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Effect of adjuvant use of metformin on periodontal treatment: a systematic review and meta-analysis

Abstract

Objective

The aim of the study was to perform a systematic review of the literature regarding the adjuvant effects of metformin on the results of mechanical periodontal treatment.

Methods

First, a search on the PubMed, EMBASE, and Scopus databases was performed up to March 2018. Randomized clinical trials with at least 3 months of follow-up and using metformin associated with mechanical periodontal treatment were included in the review. As comparison group, mechanical or periodontal therapy alone or in combination with placebo. The studies should involve adults with at least 30 years of age diagnosed with chronic periodontitis. For the evaluation of the risk of bias of the articles, the Cochrane Collaboration tool was used.

Results

Studies (1912) were retrieved and 4 were included in the review. The articles are all from the same research center and used metformin in gel at concentrations of 0.5%, 1%, or 1.5%. The majority of included studies presented low risk of bias. A linear meta-analysis was conducted for probing depth and clinical attachment loss outcomes. The results showed a weighted mean difference of 2.12 mm (95% CI 1.83–2.42) and 2.29 mm (95% CI 1.72–2.86) for probing depth and clinical attachment level, respectively, favoring the group exposed to 1% adjunct metformin.

Conclusion

The adjuvant use of metformin may promote an additional benefit to the results of mechanical periodontal therapy.

Clinical significance

The metformin as an adjuvant on periodontal treatment shows potential to reduce needs of additional interventions and also reduces the inflammatory burden in patients.

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Commentary: Risk Factors for Basal Cell Carcinoma in Men Younger Than 40 Years of Age A Case–Control Study

No abstract available

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Green Light photoselective vaporization of the prostate: a safe and effective treatment for elderly high-risk benign prostate hyperplasia patients with gland over 80 ml

Abstract

To analyze the efficacy of Green Light photoselective vaporization of the prostate (PVP) in elderly high-risk benign prostatic hyperplasia (BPH) patients with glands over 80 ml. From December 2013 to February 2016, we allocated 84 elderly (age 71–97) high-risk patients who underwent preoperative transrectal ultrasound (TRUS) examination with glands over 80 ml and divided them into two groups to receive 120 W (n = 40) and 180 W (n = 44) PVP. All the patients have been observed at least one intraoperative comorbidity: hypertension, diabetes mellitus, NYHA II, or combined. They were followed up for 12 months. All the conventional parameters were compared in this study. All the patients received successful operations without severe complications, and no patient needed blood transfusion. The operation time and catheterization time of the 180 W patients were significantly shorter than that of the 120 W patients (p < 0.05). The International Prostate Symptom Scores (IPSS), quality of life (QoL) scores, maximum flow rate (Qmax), and residual urine volume (RUV) in both groups have been significantly improved. PVP is safe and effective for high-risk aging patients with gland over 80 ml. In addition, 180 W XPS system has a short operation time and catheterization time and less inflammatory response.

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Effects of low-level laser therapy on soft and hard tissue healing after endodontic surgery

Abstract

The aim of this prospective study was to examine possible benefits of low-level laser therapy (LLLT) on soft and hard tissue healing after endodontic surgery. Seventy-six endo-surgery cases on maxillary incisors were included. The patients were assigned randomly into control and laser groups. In the laser group, gallium-aluminum-arsenide (GaAlAs) diode laser irradiation (810 nm, 129 mW, 3.87 J/cm²) was performed immediately after surgery and daily for postoperative 7 days from buccal and palatal surfaces (5 min for each side). In the control group, patients were not subjected laser therapy. The patients were compared in terms of pain, clinical and radiological findings, and life quality indexes [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)]. Seventy-one patients completed the study (n = 37 for control group, n = 34 for laser group). The laser group showed better results in edema, wound healing, and the number of analgesic tablets used on the 1st, 3rd, and 7th postoperative days. Significant reduction in ecchymoses was observed in the laser group on the postop 3rd and 7th days. The patients had significantly lower pain on the 1st and 3rd postop days in laser group. The laser group showed significantly better results in OHIP-14 and GOHA indexes on postop days 1 and 3. The laser group showed significantly favorable results in terms of bone density, defect volume and area, and periapical index in the postop 3rd month. This study concluded that LLLT improved soft and hard tissue healing after endodontic surgery and also showed favorable effects on pain and life quality of patients especially in the early phase of healing period.

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Correction to: Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans

The author found small mistakes in scientific content of article. Editor-in-Chief confirmed that mistakes do not change or invalidate conclusions of article.

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Appropriate laser wavelengths for photodynamic therapy with methylene blue

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Resistance to vertical root fracture of apicoected teeth using different devices during two root canal irrigation procedures

Abstract

The aim of the present work was to measure the fracture resistance of endodontically treated teeth that were apicoected with different procedures. Seventy-two extracted human maxillary anterior teeth were included in this study. The specimens were randomly assigned to three main groups according to the apical surgery procedures and then two subgroups according to the irrigation protocols during root canal treatment and total of six groups were obtained (n = 12). Group 1: served as a control and apical surgery process was not performed in this group. Group 2: apical surgery process was performed with tungsten carbide fissure bur Group 3: apical surgery process was performed with Er:YAG laser. Subgroup a: In this group, the specimens were irrigated with %5 NaOCl. Subgroup b: 15% EDTA solution was filled into the root canal and then agitated using a 1.5 W/100 Hz diode laser. The specimens were filled and mounted in acrylic resin blocks and compression strength test was performed. Statistical analysis was performed using two-way ANOVA. The statistical analysis revealed that there were no statistical significant differences between apical surgery procedures (groups 1, 2, and 3) (p < 0.05). Apical resection procedures did not affect the fracture resistance Significant differences were determined between the subgroups (p < 0.05). Agitation of the EDTA with the diode laser reduced the fracture resistance of the specimens. The different canal irrigation techniques altered resistance to fracture; however, apical surgery procedures did not altered the resistance to fracture when compared with the control group.

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