PurposeThe purpose of this study was to investigate the safety and efficacy of the combination of robot‐assisted percutaneous screw placement and pelvic internal fixator (INFIX) for minimally invasive treatment of unstable anterior and posterior pelvic ring injuries.MethodsFrom September 2016 to June 2017, twenty‐four patients with unstable anterior and posterior pelvic ring injuries were treated with TiRobot‐assisted percutaneous sacroiliac cannulated screw fixation on the posterior pelvic ring combined with robot‐assisted pedicle screw placement in the anterior inferior iliac spine along with INFIX on the anterior pelvic ring. The results of the treatment, including surgery duration, fluoroscopy frequency, total drilling, amount of blood loss, fracture healing time, and postoperative functional outcomes were recorded and compared with another 21 similar patients who underwent conventional manual positioning surgery.ResultsThe TiRobot group incurred significantly shorter duration of surgery; less fluoroscopy frequency, intraoperative bleeding, and total drilling than in the conventional group (P < 0.05). Postoperative radiological follow‐up showed that all screws were in the safe area and no screw penetrated the cortex. All wounds healed by primary intention and no iatrogenic damage to the blood vessels, nerves, and organs occurred. Patients showed good tolerance to INFIX and reported no discomfort. The mean follow‐up duration was 5.4 months; the fractures were all healed, no loss of reduction occurred, and the mean Majeed score at the last follow‐up did not show any difference.ConclusionTiRobot‐assisted percutaneous screw placement combined with INFIX for the anterior and posterior pelvic ring injuries is accurate, safe, less invasive, and shows satisfactory efficacy, suggesting it is a better method for minimally invasive treatment of unstable pelvic ring fractures.

Objective To investigate the indications, surgical strategy and techniques, safety, and efficacy of robot‐assisted minimally‐invasive internal fixation of pelvic ring injuries. Methods The clinical data of 86 patients with anterior and posterior pelvic ring injuries who underwent robot‐assisted minimally‐invasive internal fixation were retrospectively analyzed. The patients included 57 men and 29 women aged between 22 and 75 years, with an average age of (40.2 ± 13.6) years. According to the Tile classification, there were 5 (5.8%) type A2, 48 (55.8%) type B, and 33 (38.4%) type C fractures. The surgical plans were formulated based on the injury type of the pelvic ring, the effectiveness of the reduction, and the integrity of the osseous channel. Posterior pelvic ring injuries were treated with robot‐assisted percutaneous cannulated screw fixation of the sacroiliac joint. Anterior pelvic ring injuries were treated with robot‐assisted percutaneous cannulated screw fixation of the pubic ramus, INFIX fixation, or a “hybrid” fixation. The surgical complications and the efficacy of the surgical treatments were analyzed. Results A total of 274 screws were inserted with robotic assistance, of which 262 screws were successfully inserted to a satisfactory position on the first attempt. The number of screws placed per person was 3.2 on average, and the average operation time was 175 min (35–280 min). Fluoroscopies were performed an average of 29.1 times (range, 9–63 times), and it took 6.1 s to place each screw. There were 13 unsatisfactory guiding needle placements during the surgeries, among 7 of which cutting or penetration of the cortex was re‐planned until satisfactory insertions; 1 penetrated the pubic cortex, causing hemorrhage of the “crown of death,” and was changed to “hybrid surgery”. The robot‐assisted surgical wounds all healed by primary intention with satisfactory position and precision of screw insertions. All patients were followed up for 3–6 months, with an average of 4.2 months. There were two postoperative fixation failures, in which both patients had separated symphysis pubes after hybrid surgery. The average Majeed score at the last follow‐up was 92.4 points. Conclusions Robot‐assisted surgery is accurate and minimally invasive, with a high success rate for one‐time screw placement and satisfactory clinical results. The indications and surgical strategy should be rigorously selected, the level of surgical techniques mastered, and the operating procedures standardized, all of which may help to prevent surgical complications. Robot‐assisted surgery provides a novel modality for the minimally‐invasive treatment of pelvic ring injuries.

BackgroundTreating acute injury of the heel fat pad is different from treating common soft tissue damage. Due to the paucity of literature on the topic, we described our initial experience treating acute injury of the heel fat pad to determine the ideal treatment method.Material/MethodsA total of 53 patients with acute injury of the heel fat pad admitted to our hospital were selected for the study and were randomly divided into 2 groups: the compressed fixation combined with vacuum-assisted closure group and the only reimplanted and sewn group. Twenty-seven of the heel fat pads were compressed and fixed using a flat, hard piece of plastic and hollow screws; then, they were covered with a vacuum-assisted closure device. The other 27 were only sewn without tension. The clinical results were evaluated according to the American Orthopedic Foot and Ankle Society hindfoot score and the British Medical Research Council function evaluation criteriaResultsIn the compressed fixation combined with vacuum-assisted closure group, flaps of 12 feet with retrograde avulsion injury survived successfully. Partial flap necrosis occurred in 8 feet. Seven feet underwent repair using the neurocutaneous vascular resupinated island flap. Results were excellent or good for 74% of patients according to the AOFS. However, in the only reimplanted and sewn group, results were excellent or good for 44% of patients according to the AOFS.ConclusionsCompressed fixation with vacuum-assisted closure is effective for treating acute injury of the heel fat pad, with high success rates and good utility.

The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups ( P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection ( P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients ( P < 0.05), but there was no difference in Grade I patients ( P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.

The TriVex procedure for the removal of benign superficial masses is simple, safe, and effective with advantages of short operation time, small incisions, and good cosmetic outcome, which is predicted as a new minimally invasive surgery of superficial masses.

The objective of this study was to determine a classification system for BN in incarcerated groin hernia patients and to explore the possible relationship between BN staging and patient outcomes. Incarcerated groin hernia patients treated with emergency bowel resection from January 2008 to December 2013 were screened for inclusion in a prospective study. A novel three-stage classification system was proposed for BN (BN stages I–III) and correlations between adverse events (AEs) and mortality with BN stage were determined. A total of 108 patients were included, with 71, 26, and 11 patients in BN stages I, II, and III, respectively. AEs, which included wound and intra-abdominal infections and other systemic complications, increased with higher BN stage (all P < 0.05). Mortality increased with BN stage, with 2.8%, 7.7%, and 27.3% at BN stages I, II, and III, respectively (P < 0.05). The proposed BN staging system can objectively reflect the degree of bowel damage and its corresponding adverse outcomes.

BackgroundThere is currently no grading standard for the degree of clinical and bowel morphological changes. The objective of this study was to define clinical and bowel morphological classifications and investigate the possible relationship with the characteristics of patients with incarcerated groin hernias.Material/MethodsWe retrospectively studied 195 patients who underwent emergency hernia repair with simultaneous bowel resection between January 1992 and January 2012. We classified the degree of clinical and bowel morphological changes into 3 grades based on the incarceration time, intestinal morphology after damage, hernia sac integrity, degree of inflammation, and the presence/absence of bacterial growth, peritonitis signs, mechanical obstruction, cellulitis, and systemic shock. We also recorded patient characteristics and analyzed their relationships with these degrees according to our grading system.ResultsWe identified 134, 42, and 19 cases of Grades I, II, and III of clinical and bowel morphological changes, respectively. Pearson’s chi-squared tests revealed that advanced age (P=0.001), presence of comorbid disease (P=0.002), and high American Society of Anesthesiologists (ASA) score (P=0.017) were related to the degree. Morbidity and mortality also showed significant relationships with the degree (P<0.001, P=0.005, respectively), especially with regard to post-operative infection.ConclusionsThe proposed 3-stage classifications of clinical and bowel morphological changes can be used to objectively reflect the degree of bowel damage. Greater levels of the changes were associated with higher incidences of complications and increased mortality, especially for older patients with comorbid diseases and poor ASA scores. Urgent surgery should be performed to avoid bowel damage exacerbation.

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