Background The researchers are trying to evaluate the measurement of: Intact parathyroid hormone (iPTH) and serum total calcium (sCa) levels for predicting hypocalcemia after total thyroidectomy (TT). Methods The sample of this single center prospective study consists of (100) patients, where (77) females and (23) males with an age range between (28) and (65) (the mean level is, 48.17 ± 6.54). These selected patients underwent total thyroidectomy (TT) in the general surgery department, Benha university hospital from the period of June 2019 to February 2020. Levels of sCa and iPTH were measured aat several times preoperatively, 10 min, 48 h, 3, 6, 9 months, and 1 year after being after gone TT. Results Among the entire study sample, 23 patients (23%) developed transient hypoparathyroidism and hypocalcemia (˂8.5 mg/dl), none of them developed permanent hypoparathyroidism and hypocalcemia. The cut-off point of PTH has been 10 min after TT was at 23 pg/mL as it was the best compromise between sensitivity and specificity for predicting hypocalcaemia. It has been found that Patients who have a PTH greater than 23 pg/mL can be discharged safely after 24 h. Patients who have PTH of less than 23 pg/mL were observed for an additional 24 h, and the study found that timely treatment initiation is recommended. A PTH ˂ 10 pg/mL measured at 48 h after surgery had a sensitivity, specificity as well as an accuracy of 100%, for predicting hypocalcemia after TT. The accuracy of a single PTH concentration at 48 h was useful for predicting hypocalcemia [Area under receiver–operator characteristic curve (AUC) 1; confidence interval (CI), 95%, 0.85–0.94]. Conclusion Patients with iPTH ˂ 10 pg/mL, and sCa levels ˂ 7.4 mg/dL are at higher risk of developing hypoparathyroidism and hypocalcemia after TT.
Background The latissimus dorsi muscle (LDM) is a flexible muscle that is frequently employed in various reconstructive operations. Breast-conserving surgery is widely acknowledged as an effective treatment for breast cancer, and the latissimus dorsi muscle flap is a straightforward, dependable technique for partial breast reconstruction. Methods A pedicled segmental latissimus dorsi muscle flap was employed in 20 patients with laterally situated breast cancer treated at our institution from January 2018 to December 2021. During a 6-month postoperative follow-up period, patients were polled on their overall satisfaction and cosmetic satisfaction. Plastic surgeons assessed the aesthetic and functional outcomes in terms of breast shape and symmetry, as well as muscular function. Results The mean operative time was 120 ± 35.2 min while the mean postoperative hospital stay was 2.5 days (range, 1.5–3 days). There were no donor site complications such as intraoperative bleeding, postoperative hematoma, or infection, and postoperative drain removal was done on average after 5 days. The average weight of specimens was 50–160 gm with a mean of 100 gm, and the locations of the masses were the upper lateral quadrant (n = 15), the lower lateral quadrant (n = 2), and the central lateral area (n = 3). Complications developed in 6 of the cases, hematoma in 2 cases, wound seroma developed in the donor site in 2 cases, and weakness in shoulder movement in 2 cases, and the majority of the patients were satisfied with their cosmetic outcomes. No tumor recurrence was reported. Conclusion Replacement of 20 to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap as nerve-sparing pedicled segmental flap that can be harvested from the same axillary incision of lymphadenectomy is a good alternative reconstruction technique after partial mastectomy. This resulted in an acceptable postoperative scar, less pain, and early upper extremity movement, so this technique is considered a useful and reliable technique in correcting breast deformity after breast-conserving surgery, especially in laterally located breast cancer. Level of evidence: Level IV, therapeutic study.
Background: Pilonidal disease is persistent sacrococcygeal inflammation and infection. Theories include congenital and acquired causes. Karydakis and Limberg flaps can treat pilonidal sinus. The conventional method replaces the vulnerable raphe with healthy tissue. The Karydakis flap was modified by suturing its base to the wound's lateral border. Limberg flap involves excision of rhomboid area down to presacral fascia and transposition of fasciocutaneous flap medially to cover defect without strain. The flap matched the rhomboid area. Aim: to compare the Karydakis technique and the Limberg flap approach for surgically treating pilonidal sinus disease in terms of wound healing, wound complications, recurrence rate, satisfaction and time to return to work. Subject and Methods: 50 patients with sacrococcygeal pilonidal sinus illness participated in this prospective study, which was divided randomly into two groups.Results: In the Limberg Flap group, After surgery, there was a highly significant reduction in pain and healing in the Limberg Flap group. Between the two groups, there was no discernible difference in the time it took for complete healing. In the Limberg Flap group, satisfaction was noticeably higher.Regarding affected location, there was no discernible difference between the two groups among the included individuals. Conclusion: Pilonidal disease patients typically receive therapy with Limberg flap surgery. In comparison to Karydakis flap surgery, it is less problematic, quicker to return to work, more patient-satisfied overall, and heals wounds more quickly.
Background: Contracted scars of the neck involving the anterior cervical zone constitute a unique group of challenges compared with post-burn complications in other parts of the body. Many techniques have been advocated for reconstructing neck contractures.Purpose: To determine and recommend the ideal skin cover for neck contracture release defects with regard to both functional and cosmetic outcomes.Methods: A prospective and retrospective cohort study included 20 patients with various degrees of contracted scars of the neck. After releasing contracture band and resection of the unfavorable scarred tissue, remaining defects were surgically reconstructed using multiple Z-Plasties, STSGs, FTSGs and supraclavicular artery island flap with or without prior usage of a tissue expander.Results: Excision and flap group have a higher significant functional outcome than excision with graft and Multiple Z-Plasty groups (p=0.031). Also, excision and flap have a lower non-significant Vancouver scar scale than other reconstruction methods without significant differences between groups. Excision and flap group have higher Patient Satisfaction score than Excision and graft and Multiple Z-Plasty groups without significant differences between groups. Conclusion:Local and regional flaps especially the supraclavicular artery island flap provide a predictable reconstruction option not only with better color and texture match but also achieves a superior functional outcome.Approval from the Research Ethics Committee in Benha Faculty of Medicine was granted and a fully informed written consents were taken from all patients regarding surgical procedure, photographing, possible complications and followup period.
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