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  • 151.
    de Graaf, Nine
    et al.
    Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, iTALY; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, Netherlands.
    Emmen, Anouk M. L. H.
    Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, iTALY; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, Netherlands.
    Ramera, Marco
    Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
    Björnsson, Bergthor
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Boggi, Ugo
    Department of Surgery, Universitá Di Pisa, Pisa, Italy.
    Bruna, Caro L.
    Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, iTALY; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, Netherlands.
    Busch, Olivier R.
    Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, Netherlands.
    Daams, Freek
    Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, Netherlands.
    Ferrari, Giovanni
    Department of Surgery, Niguarda Ca’Granda Hospital, Milan, Italy.
    Festen, Sebastiaan
    Cancer Center Amsterdam, Amsterdam, Netherlands.
    van Hilst, Jony
    Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, NetherlandsDepartment of Surgery, OLVG, Amsterdam, Netherlands.
    D’Hondt, Mathieu
    Department of Surgery, AZ Groeninge, Kortrijk, Belgium.
    Ielpo, Benedetto
    Department of Surgery, Hospital del Mar, Barcelona, Spain.
    Keck, Tobias
    Department of Surgery, UKSH Campus Lübeck, Lübeck, Germany.
    Khatkov, Igor E.
    Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.
    Koerkamp, Bas Groot
    Department of Surgery, Erasmus MC, Rotterdam, Netherlands.
    Lips, Daan J.
    Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands.
    Luyer, Misha D. P.
    Department of Surgery, Catharina Ziekenhuis, Eindhoven, Netherlands.
    Mieog, J. Sven D.
    Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.
    Morelli, Luca
    General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
    Molenaar, I. Quintus
    Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands .
    van Santvoort, Hjalmar C.
    Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands .
    Sprangers, Mirjam A. G.
    Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Ferrari, Clarissa
    Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, 25123, Italy.
    Berkhof, Johannes
    Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, Netherlands.
    Maisonneuve, Patrick
    Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy.
    Abu Hilal, Mohammad
    Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, 25123, Italy.
    Besselink, Marc G.
    Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Amsterdam, Netherlands.
    Minimally invasive versus open pancreatoduodenectomy for pancreatic and peri-ampullary neoplasm (DIPLOMA-2): study protocol for an international multicenter patient-blinded randomized controlled trial2023In: Trials, E-ISSN 1745-6215, Vol. 24, no 1, article id 665Article in journal (Refereed)
    Abstract [en]

    Background: Minimally invasive pancreatoduodenectomy (MIPD) aims to reduce the negative impact of surgery as compared to open pancreatoduodenectomy (OPD) and is increasingly becoming part of clinical practice for selected patients worldwide. However, the safety of MIPD remains a topic of debate and the potential shorter time to functional recovery needs to be confirmed. To guide safe implementation of MIPD, large-scale international randomized trials comparing MIPD and OPD in experienced high-volume centers are needed. We hypothesize that MIPD is non-inferior in terms of overall complications, but superior regarding time to functional recovery, as compared to OPD. Methods/design: The DIPLOMA-2 trial is an international randomized controlled, patient-blinded, non-inferiority trial performed in 14 high-volume pancreatic centers in Europe with a minimum annual volume of 30 MIPD and 30 OPD. A total of 288 patients with an indication for elective pancreatoduodenectomy for pre-malignant and malignant disease, eligible for both open and minimally invasive approach, are randomly allocated for MIPD or OPD in a 2:1 ratio. Centers perform either laparoscopic or robot-assisted MIPD based on their surgical expertise. The primary outcome is the Comprehensive Complication Index (CCI®), measuring all complications graded according to the Clavien-Dindo classification up to 90 days after surgery. The sample size is calculated with the following assumptions: 2.5% one-sided significance level (α), 80% power (1-β), expected difference of the mean CCI® score of 0 points between MIPD and OPD, and a non-inferiority margin of 7.5 points. The main secondary outcome is time to functional recovery, which will be analyzed for superiority. Other secondary outcomes include post-operative 90-day Fitbit™ measured activity, operative outcomes (e.g., blood loss, operative time, conversion to open surgery, surgeon-reported outcomes), oncological findings in case of malignancy (e.g., R0-resection rate, time to adjuvant treatment, survival), postoperative outcomes (e.g., clinically relevant complications), healthcare resource utilization (length of stay, readmissions, intensive care stay), quality of life, and costs. Postoperative follow-up is up to 36 months. Discussion: The DIPLOMA-2 trial aims to establish the safety of MIPD as the new standard of care for this selected patient population undergoing pancreatoduodenectomy in high-volume centers, ultimately aiming for superior patient recovery. Trial registration: ISRCTN27483786. Registered on August 2, 2023. © 2023, BioMed Central Ltd., part of Springer Nature.

  • 152.
    DeAngelis, Nicola
    et al.
    Gen Reg Hosp F Miulli, Italy; Univ Paris Est, France; Univ Paris Est, France.
    Catena, Fausto
    Univ Hosp Parma, Italy.
    Memeo, Riccardo
    Gen Reg Hosp F Miulli, Italy.
    Coccolini, Federico
    Pisa Univ Hosp, Italy.
    Martinez-Perez, Aleix
    Hosp Univ Doctor Peset, Spain.
    Romeo, Oreste M.
    Bronson Methodist Hosp, MI USA.
    De Simone, Belinda
    Ctr Hosp Poissy St Germain en Laye, France.
    Di Saverio, Salomone
    Cambridge Univ Hosp, England.
    Brustia, Raffaele
    Univ Paris Est, France; Univ Paris Est, France.
    Rhaiem, Rami
    Robert Debre Univ Hosp, France.
    Piardi, Tullio
    Robert Debre Univ Hosp, France; Troyes Hosp, France.
    Conticchio, Maria
    Gen Reg Hosp F Miulli, Italy.
    Marchegiani, Francesco
    Univ Padua, Italy.
    Beghdadi, Nassiba
    Univ Paris Est, France; Univ Paris Est, France.
    Abu-Zidan, Fikri M.
    UAE Univ, U Arab Emirates.
    Alikhanov, Ruslan
    Moscow Clin Sci Ctr, Russia.
    Allard, Marc-Antoine
    Hop Paul Brousse, France.
    Allievi, Niccolo
    Papa Giovanni Hosp XXIII, Italy.
    Amaddeo, Giuliana
    Univ Paris Est, France; Henri Mondor Univ Hosp, France.
    Ansaloni, Luca
    San Matteo Univ Hosp, Italy.
    Andersson, Roland
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Andolfi, Enrico
    San Donato Hosp, Italy.
    Azfar, Mohammad
    Al Rahba Hosp, U Arab Emirates.
    Bala, Miklosh
    Hadassah Hebrew Univ, Israel.
    Benkabbou, Amine
    Mohammed V Univ Rabat, Morocco.
    Ben-Ishay, Offir
    Rambam Healthcare Campus, Israel.
    Bianchi, Giorgio
    Gen Reg Hosp F Miulli, Italy.
    Biffl, Walter L.
    Scripps Mem Hosp La Jolla, CA USA.
    Brunetti, Francesco
    Univ Paris Est, France; Univ Paris Est, France.
    Carra, Maria Clotilde
    Rothschild Hosp, France; Univ Paris, France.
    Casanova, Daniel
    Univ Cantabria, Spain.
    Celentano, Valerio
    Chelsea & Westminster Hosp, England.
    Ceresoli, Marco
    Univ Milano Bicocca, Italy.
    Chiara, Osvaldo
    Univ Milan, Italy.
    Cimbanassi, Stefania
    Univ Milan, Italy.
    Bini, Roberto
    Univ Milan, Italy.
    Coimbra, Raul
    Riverside Univ, CA USA; Loma Linda Univ, CA USA.
    Luigi deAngelis, Gianm
    Univ Parma, Italy.
    Decembrino, Francesco
    Gen Reg Hosp F Miulli, Italy.
    De Palma, Andrea
    Pisa Univ Hosp, Italy.
    de Reuver, Philip R.
    Radboud Univ Nijmegen, Netherlands.
    Domingo, Carlos
    Hosp Univ Doctor Peset, Spain.
    Cotsoglou, Christian
    ASST Vimercat, Italy.
    Ferrero, Alessandro
    Azienda Osped Ordine Mauriziano Umberto I, Italy.
    Fraga, Gustavo P.
    Univ Campinas Unicamp, Brazil.
    Gaiani, Federica
    Univ Parma, Italy.
    Gheza, Federico
    Univ Brescia, Italy.
    Gurrado, Angela
    Univ Bari Aldo Moro, Italy.
    Harrison, Ewen
    Univ Edinburgh, Scotland; Univ Edinburgh, Scotland.
    Henriquez, Angel
    Ctr Medico Laparoscop, El Salvador.
    Hofmeyr, Stefan
    Univ Stellenbosch, South Africa.
    Iadarola, Roberta
    Univ Hosp Parma, Italy.
    Kashuk, Jeffry L.
    Tel Aviv Univ, Israel.
    Kianmanesh, Reza
    Robert Debre Univ Hosp, France.
    Kirkpatrick, Andrew W.
    Foothills Med Ctr, Canada.
    Kluger, Yoram
    Rambam Healthcare Campus, Israel.
    Landi, Filippo
    Univ Barcelona, Spain.
    Langella, Serena
    Azienda Osped Ordine Mauriziano Umberto I, Italy.
    Lapointe, Real
    Ctr Hosp Univ Montreal, Canada.
    Le Roy, Bertrand
    Univ Hosp St Etienne, France.
    Luciani, Alain
    Univ Paris Est, France; Henri Mondor Univ Hosp, France.
    Machado, Fernando
    Hosp Clin Montevideo, Uruguay.
    Maggi, Umberto
    Osped Maggiore Policlin Milano, Italy.
    Maier, Ronald V.
    Univ Washington, WA 98195 USA.
    Mefire, Alain Chichom
    Reg Hosp, Cameroon.
    Hiramatsu, Kazuhiro
    Toyohashi Municipal Hosp, Japan.
    Ordonez, Carlos
    Univ Valle Cali, Colombia.
    Patrizi, Franca
    Maggiore Hosp, Italy.
    Planells, Manuel
    Hosp Univ Doctor Peset, Spain.
    Peitzman, Andrew B.
    Univ Pittsburg, KS USA.
    Pekolj, Juan
    Hosp Italiano Buenos Aires, Argentina.
    Perdigao, Fabiano
    Hop La Pitie Salpetriere, France.
    Pereira, Bruno M.
    Univ Campinas Unicamp, Brazil.
    Pessaux, Patrick
    Univ Strasbourg, France.
    Pisano, Michele
    Papa Giovanni Hosp XXIII, Italy.
    Puyana, Juan Carlos
    Univ Pittsburgh, PA USA.
    Rizoli, Sandro
    St Michaels Hosp, Canada.
    Portigliotti, Luca
    Azienda Osped Univ Maggiore Carita, Italy.
    Romito, Raffaele
    Azienda Osped Univ Maggiore Carita, Italy.
    Sakakushev, Boris
    Med Univ, Bulgaria.
    Sanei, Behnam
    Isfahan Univ Med Sci, Iran.
    Scatton, Olivier
    Univ Paris Est, France; Henri Mondor Hosp, France.
    Serradilla-Martin, Mario
    Hosp Univ Miguel Servet, Spain.
    Schneck, Anne-Sophie
    Ctr Hosp Univ Guadeloupe, France.
    Sissoko, Mohammed Lamine
    Hop Natl Blaise Compaore Ouagadougou, Burkina Faso.
    Sobhani, Iradj
    Univ Paris Est, France; Henri Mondor Hosp, France.
    ten Broek, Richard P.
    Radboud Univ Nijmegen, Netherlands.
    Testini, Mario
    Univ Bari Aldo Moro, Italy.
    Valinas, Roberto
    Clin Hosp Dr Manuel Quintela, Uruguay.
    Veloudis, Giorgos
    Vet Fund Army Hosp, Greece.
    Vitali, Giulio Cesare
    Geneva Univ Hosp, Switzerland.
    Weber, Dieter
    Royal Perth Hosp, Australia.
    Zorcolo, Luigi
    Univ Cagliari, Italy.
    Giuliante, Felice
    Fdn Policlin Univ A Gemelli, Italy.
    Gavriilidis, Paschalis
    Imperial Coll HealthCare, England.
    Fuks, David
    Inst Mutualiste Montsouris, France.
    Sommacale, Daniele
    Univ Paris Est, France; Univ Paris Est, France.
    2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy2021In: World Journal of Emergency Surgery, E-ISSN 1749-7922, Vol. 16, no 1, article id 30Article, review/survey (Refereed)
    Abstract [en]

    Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

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  • 153.
    Demmer, Sina
    et al.
    Heidelberg Univ, Germany.
    Kleindienst, Nikolaus
    Heidelberg Univ, Germany.
    Hjortswang, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Thomann, Philipp
    Odenwald Dist Healthcare Ctr, Germany.
    Ebert, Matthias
    Heidelberg Univ, Germany.
    Reindl, Wolfgang
    Heidelberg Univ, Germany.
    Thomann, Anne
    Heidelberg Univ, Germany.
    Validation of the German version of the Short Health Scale - a brief, valid and reliable instrument to assess health-related quality of life in German-speaking patients with inflammatory bowel diseases2023In: Zeitschrift für Gastroenterologie - German Journal of Gastroenterology, ISSN 0044-2771, E-ISSN 1439-7803, Vol. 61, no 09, p. 1207-1213Article in journal (Refereed)
    Abstract [en]

    Background Health-related quality of life (hrQoL) may be the most important patient-reported outcome for patients with chronic disorders. The Short Health Scale (SHS) is a brief four-item instrument to assess hrQoL in patients with bowel disorders. This study examined the validity, reliability and sensitivity of the German translation of the SHS in a cohort of outpatients with inflammatory bowel diseases (IBD).Methods The study was preregistered in April 2021 ( https://doi.org/10.17605/OSF.IO/S82D9 ). Outpatients with IBD (n=225) in different stages of disease activity (as determined by the Harvey-Bradshaw index or partial Mayo score) completed the German SHS and the short Inflammatory Bowel Disease Questionnaire (sIBDQ) as an established measure of hrQoL to examine the convergent validity. To assess reliability, a subset of patients (n=30) in remission completed the same questionnaires after 4-8 weeks. Sensitivity to change was established from questionnaires of patients with either decreased (n=15) or increased (n=16) disease activity after 3-6 months.Results The internal consistency of the German SHS was high (Cronbachs a=0.860). SHS total scores correlated strongly with sIBDQ scores (?=-0.760, p<0.001) and disease activity (?=0.590, p<0.001). Retest reliability was high (?=0.695, p<0.001). Sensitivity to change was statistically significant for patients with decreased (p=0.013) but not increased (p=0.134) disease activity.Conclusion The German version of the SHS is a valid and reliable tool to measure hrQoL in persons with IBD.

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  • 154.
    Deputy, Mohammed
    et al.
    St Marks Hosp & Acad Inst, England; Imperial Coll London, England.
    Worley, Guy
    St Marks Hosp & Acad Inst, England; Imperial Coll London, England.
    Patel, Komal
    St Marks Hosp & Acad Inst, England; Imperial Coll London, England.
    Fletcher, Jordan
    St Marks Hosp & Acad Inst, England; Imperial Coll London, England.
    Hart, Ailsa
    St Marks Hosp & Acad Inst, England; Imperial Coll London, England.
    Block, Mattias
    Salhgrenska Univ Hosp, Sweden.
    Oresland, Tom
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Myrelid, Pär
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Faiz, Omar
    St Marks Hosp & Acad Inst, England; Imperial Coll London, England.
    Long-term outcome and quality of life after continent ileostomy for ulcerative colitis: A systematic review2021In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 23, no 9, p. 2286-2299Article, review/survey (Refereed)
    Abstract [en]

    Aim The continent ileostomy allows evacuation of an ileal reservoir at a time convenient to the patient. It is a surgical option for patients with ulcerative colitis (UC) when a restorative option is not suitable or has not succeeded and the patient does not want a conventional end ileostomy. Continent ileostomy types include the Kock pouch, Barnett continent intestinal reservoir and T-pouch. All of the published evidence on the long-term outcome and quality of life after continent ileostomy for UC was systematically reviewed. Methods A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1990 and 2020 were included. A descriptive synthesis was used due to the clinical heterogeneity. Results The search returned 1655 abstracts and after screening of abstracts and full text review, 19 were included in the final review, involving 1602 patients. Operative mortality is low (0%-3.6%) after all types of continent ileostomy but reoperation rates are high (20.8%-65%) because of valve mechanism failures. Rates of fistulae (0%-25.5%) and stomal stenosis (0%-25%) can be relatively high postoperatively. Quality of life scores improve for most patients undergoing continent ileostomy, especially for patients converted from ileal pouch anal anastomosis. Overall, continent ileostomy retention is high in the long-term. Discussion In the long-term, patients report high satisfaction and a good quality of life with continent ileostomy, despite high reoperation rates and complications. Newer technologies may reinvigorate interest in the continent ileostomy for this population.

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  • 155.
    Di Saverio, Salomone
    et al.
    AUSL, Italy.
    Birindelli, Arianna
    University of Bologna, Italy.
    Kelly, Micheal D.
    Canberra Hospital, Australia.
    Catena, Fausto
    Maggiore Hospital Parma, Italy.
    Weber, Dieter G.
    Trauma and Gen Surgeon Royal Perth Hospital, Australia; University of Western Australia, Australia.
    Sartelli, Massimo
    Macerata Hospital, Italy.
    Sugrue, Michael
    Letterkenny Hospital, Ireland.
    De Moya, Mark
    Harvard Medical Sch, MA USA.
    Augusto Gomes, Carlos
    University of Gen Juiz de Fora, Brazil.
    Bhangu, Aneel
    University Hospital Birmingham NHS Fdn Trust, England.
    Agresta, Ferdinando
    Civil Hospital, Italy.
    Moore, Ernest E.
    Denver Health Medical Centre, CO USA.
    Soreide, Kjetil
    Stavanger University Hospital, Norway.
    Griffiths, Ewen
    University Hospital Birmingham NHS Fdn Trust, England.
    De Castro, Steve
    OLVG, Netherlands.
    Kashuk, Jeffry
    University of Jerusalem, Israel.
    Kluger, Yoram
    Rambam Health Care Campus, Israel.
    Leppaniemi, Ari
    University of Helsinki, Finland.
    Ansaloni, Luca
    Papa Giovanni XXIII Hospital, Italy.
    Andersson, Manne
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Coccolini, Federico
    Papa Giovanni XXIII Hospital, Italy.
    Coimbra, Raul
    UCSD Health Syst, CA USA.
    Gurusamy, Kurinchi S.
    UCL, England.
    Cesare Campanile, Fabio
    San Giovanni Decollato Andosilla Hospital, Italy.
    Biffl, Walter
    University of Hawaii, HI USA.
    Chiara, Osvaldo
    Osped Niguarda Ca Granda, Italy.
    Moore, Fred
    University of Florida, FL USA.
    Peitzman, Andrew B.
    University of Pittsburgh, PA USA.
    Fraga, Gustavo P.
    University of Estadual Campinas, Brazil.
    Costa, David
    Alicante, Spain.
    Maier, Ronald V.
    University of Washington, WA USA.
    Rizoli, Sandro
    St Michaels Hospital, Canada.
    Balogh, Zsolt J.
    John Hunter Hospital, Australia.
    Bendinelli, Cino
    John Hunter Hospital, Australia.
    Cirocchi, Roberto
    University of Perugia, Italy.
    Tonini, Valeria
    University of Bologna, Italy.
    Piccinini, Alice
    AUSL, Italy.
    Tugnoli, Gregorio
    AUSL, Italy.
    Jovine, Elio
    AUSL, Italy.
    Persiani, Roberto
    Catholic University, Italy.
    Biondi, Antonio
    University of Catania, Italy.
    Scalea, Thomas
    R Adams Cowley Trauma Centre, MD USA.
    Stahel, Philip
    Denver Health Medical Centre, CO USA.
    Ivatury, Rao
    Virginia Commonwealth University, VA USA.
    Velmahos, George
    Harvard Medical Sch, MA USA.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis2016In: World Journal of Emergency Surgery, E-ISSN 1749-7922, Vol. 11, no 34Article, review/survey (Refereed)
    Abstract [en]

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

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  • 156.
    Di Saverio, Salomone
    et al.
    Univ Cambridge, England; Univ Insubria, Italy.
    Podda, Mauro
    Cagliari Univ Hosp, Italy.
    De Simone, Belinda
    Maggiore Hosp Parma, Italy.
    Ceresoli, Marco
    Univ Milano Bicocca, Italy.
    Augustin, Goran
    Univ Hosp Ctr Zagreb, Croatia.
    Gori, Alice
    Maggiore Hosp, Italy.
    Boermeester, Marja
    Univ Amsterdam, Netherlands.
    Sartelli, Massimo
    Macerata Hosp, Italy.
    Coccolini, Federico
    Pisa Univ Hosp, Italy.
    Tarasconi, Antonio
    Maggiore Hosp Parma, Italy.
    Angelis, Nicola de
    Henri Mondor Univ Hosp, France.
    Weber, Dieter G.
    Royal Perth Hosp, Australia; Univ Western Australia, Australia.
    Tolonen, Matti
    Univ Helsinki, Finland.
    Birindelli, Arianna
    Azienda Socio Sanitaria Terr, Italy.
    Biffl, Walter
    Univ Hawaii, HI 96822 USA.
    Moore, Ernest E.
    Denver Hlth Med Ctr, CO USA.
    Kelly, Michael
    Canberra Hosp, Australia.
    Soreide, Kjetil
    Stavanger Univ Hosp, Norway.
    Kashuk, Jeffry
    Univ Jerusalem, Israel.
    Ten Broek, Richard
    Radboud Univ Nijmegen, Netherlands.
    Gomes, Carlos Augusto
    Univ Gen Juiz de Fora, Brazil.
    Sugrue, Michael
    Letterkenny Hosp, Ireland.
    Davies, Richard Justin
    Univ Cambridge, England.
    Damaskos, Dimitrios
    Royal Infirm Edinburgh NHS Trust, Scotland.
    Leppaniemi, Ari
    Royal Perth Hosp, Australia; Univ Western Australia, Australia.
    Kirkpatrick, Andrew
    Foothills Med Ctr, Canada.
    Peitzman, Andrew B.
    Univ Pittsburgh, PA USA.
    Fraga, Gustavo P.
    FCM Unicamp, Brazil.
    Maier, Ronald V.
    Univ Washington, WA 98104 USA.
    Coimbra, Raul
    UCSD Hlth Syst Hillcrest Campus, CA USA.
    Chiarugi, Massimo
    Pisa Univ Hosp, Italy.
    Sganga, Gabriele
    Univ Cattolica Sacro Cuore, Italy.
    Pisanu, Adolfo
    Cagliari Univ Hosp, Italy.
    Angelis, Gian Luigi de
    Univ Parma, Italy.
    Tan, Edward
    Radboud Univ Nijmegen, Netherlands.
    Van Goor, Harry
    Radboud Univ Nijmegen, Netherlands.
    Pata, Francesco
    Nicola Giannettasio Hosp, Italy; Univ Roma La Sapienza, Italy.
    Di Carlo, Isidoro
    Univ Catania, Italy.
    Chiara, Osvaldo
    Osped Niguarda Ca Granda, Italy.
    Litvin, Andrey
    Immanuel Kant Balt Fed Univ, Russia.
    Campanile, Fabio C.
    San Giovanni Decollato Andosilla Hosp, Italy.
    Sakakushev, Boris
    Med Univ, Bulgaria.
    Tomadze, Gia
    Tbilisi State Med Univ, Georgia.
    Demetrashvili, Zaza
    Tbilisi State Med Univ, Georgia.
    Latifi, Rifat
    New York Med Coll, NY 10595 USA.
    Abu-Zidan, Fakri
    UAE Univ, U Arab Emirates.
    Romeo, Oreste
    Bronson Trauma Surg, MI USA.
    Segovia-Lohse, Helmut
    Univ Nacl Asuncion, Paraguay.
    Baiocchi, Gianluca
    Univ Brescia, Italy.
    Costa, David
    Hosp Univ Alicante, Spain.
    Rizoli, Sandro
    Univ Toronto, Canada.
    Balogh, Zsolt J.
    John Hunter Hosp, Australia; Univ Newcastle, Australia.
    Bendinelli, Cino
    John Hunter Hosp, Australia; Univ Newcastle, Australia.
    Scalea, Thomas
    R Adams Cowley Trauma Ctr, MD USA.
    Ivatury, Rao
    Virginia Commonwealth Univ, VA USA.
    Velmahos, George
    Harvard Med Sch, MA 02115 USA.
    Andersson, Roland
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Kluger, Yoram
    Rambam Hlth Care Campus, Israel.
    Ansaloni, Luca
    Bufalini Hosp, Italy.
    Catena, Fausto
    Maggiore Hosp Parma, Italy.
    Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines2020In: World Journal of Emergency Surgery, E-ISSN 1749-7922, Vol. 15, no 1, article id 27Article, review/survey (Refereed)
    Abstract [en]

    Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

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  • 157.
    Dietrich, Franciele
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Aspenberg, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Eliasson, Pernilla
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Dexamethasone Enhances Achilles Tendon Healing in an Animal Injury Model, and the Effects Are Dependent on Dose, Administration Time, and Mechanical Loading Stimulation2022In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 50, no 5, p. 1306-1316, article id 03635465221077101Article in journal (Refereed)
    Abstract [en]

    Background: Corticosteroid treatments such as dexamethasone are commonly used to treat tendinopathy but with mixed outcomes. Although this treatment can cause tendon rupture, it can also stimulate the tendon to heal. However, the mechanisms behind corticosteroid treatment during tendon healing are yet to be understood. Purpose: To comprehend when and how dexamethasone treatment can ameliorate injured tendons by using a rat model of Achilles tendon healing. Study Design: Controlled laboratory study. Methods: An overall 320 rats were used for a sequence of 6 experiments. We investigated whether the drug effect was time-, dose-, and load-dependent. Additionally, morphological data and drug administration routes were examined. Healing tendons were tested mechanically or used for histological examination 12 days after transection. Blood was collected for flow cytometry analysis in 1 experiment. Results: We found that the circadian rhythm and drug injection timing influenced the treatment outcome. Dexamethasone treatment at the right time point (days 7-11) and dose (0.1 mg/kg) significantly improved the material properties of the healing tendon, while the adverse effects were reduced. Local dexamethasone treatment did not lead to increased peak stress, but it triggered systemic granulocytosis and lymphopenia. Mechanical loading (full or moderate) is essential for the positive effects of dexamethasone, as complete unloading leads to the absence of improvements. Conclusion: We conclude that dexamethasone treatment to improve Achilles tendon healing is dose- and time-dependent, and positive effects are perceived even in a partly unloaded condition.

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  • 158.
    Dietrich-Zagonel, Franciele
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Hammerman, Malin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Tätting, Love
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Dietrich, Fabricia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Kozak Ljunggren, Monika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Blomgran, Parmis
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Eliasson, Pernilla T.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Stimulation of Tendon Healing With Delayed Dexamethasone Treatment Is Modified by the Microbiome2018In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 46, no 13, p. 3281-3287Article in journal (Refereed)
    Abstract [en]

    Background:

    The immune system reflects the microbiome (microbiota). Modulation of the immune system during early tendon remodeling by dexamethasone treatment can improve rat Achilles tendon healing. The authors tested whether changes in the microbiota could influence the effect of dexamethasone treatment.

    Hypothesis:

    A change in microbiome would influence the response to dexamethasone on regenerate remodeling, specifically tendon material properties (peak stress).

    Study Design:

    Controlled laboratory study.

    Methods:

    Specific opportunist and pathogen-free female rats were housed separately (n = 41) or together with specific pathogen-free rats carrying opportunistic microbes such as Staphylococcus aureus (n = 41). After 6 weeks, all co-housed rats appeared healthy but now carried S aureus. Changes in the gut bacterial flora were tested by API and RapID biochemical tests. All rats (clean and contaminated) underwent Achilles tendon transection under aseptic conditions. Flow cytometry was performed 8 days postoperatively on tendon tissue. Sixty rats received subcutaneous dexamethasone or saline injections on days 5 through 9 after transection. The tendons were tested mechanically on day 12. The predetermined primary outcome was the interaction between contamination and dexamethasone regarding peak stress, tested by 2-way analysis of variance.

    Results:

    Dexamethasone increased peak stress in all groups but more in contaminated rats (105%) than in clean rats (53%) (interaction, P = .018). A similar interaction was found for an estimate of elastic modulus (P = .021). Furthermore, dexamethasone treatment reduced transverse area but had small effects on peak force and stiffness. In rats treated with saline only, contamination reduced peak stress by 16% (P = .04) and elastic modulus by 35% (P = .004). Contamination led to changes in the gut bacterial flora and higher levels of T cells (CD3+CD4+) in the healing tendon (P < .05).

    Conclusion:

    Changes in the microbiome influence tendon healing and enhance the positive effects of dexamethasone treatment during the early remodeling phase of tendon healing.

    Clinical Relevance:

    The positive effect of dexamethasone on early tendon remodeling in rats is strikingly strong. If similar effects could be shown in humans, immune modulation by a few days of systemic corticosteroids, or more specific compounds, could open new approaches to rehabilitation after tendon injury.

  • 159.
    Dillström, Maria
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bjerså, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Engström, My
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Patients' experience of acute unplanned surgical reoperation.2017In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 209, p. 199-205Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Undergoing surgery always involves various risks of complications, often depending on the type of surgery. Because of complications, a second surgical intervention, a reoperation, must occasionally be done, which in turn often causes an extended hospital stay, a longer recovery phase, greater suffering for the patient, and higher health care costs. Even though complications after general surgery are relatively common, little is known regarding patient experience of a reoperation. Knowledge of this could impact on care models in the future. The aim of this study was to describe patients' experience of acute, unplanned reoperation during a planned hospital stay.

    MATERIALS AND METHODS: A purposive sampling strategy was used, and 16 patients were included, all who had undergone acute unplanned reoperation during a planned hospital stay. Semi-structured interviews were used to collect data, and a content analysis with an inductive approach was used for data analysis.

    RESULTS: The analysis resulted in two main themes: (1) health professionals' importance, having its foundation in categories trust and information, and (2) reaction, based on the categories anxiety and sadness.

    CONCLUSIONS: Unplanned reoperation caused psychological, social, and existential reactions. Health care professionals were perceived as important because good communication, accurate information, their presence, and creating feelings of confident and safe care were meaningful factors for the patients as they managed the situation.

  • 160.
    Divanoglou, A
    et al.
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Seiger, A
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study2010In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, no 6, p. 477-482Article in journal (Refereed)
    Abstract [en]

    Study design: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).andlt;br /andgt;Objectives: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI).andlt;br /andgt;Settings: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden.andlt;br /andgt;Methods: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry.andlt;br /andgt;Results: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki.andlt;br /andgt;Conclusions: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not. Spinal Cord (2010) 48, 477-482; doi: andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;scandlt;/highlightandgt;.andlt;highlightandgt;2009.160andlt;/highlightandgt;; published online 22 December 2009

  • 161.
    Djerf, K
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Edholm, P
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Hedbrant, Johan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, Faculty of Science & Engineering.
    A simplified roentgen stereophotogrammetric method. Analysis of small movements between the prosthetic stem and the femur after total hip replacement.1987In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 28, no 5, p. 603-606Article in journal (Refereed)
    Abstract [en]

    A simplified roentgen stereophotogrammetric method is described. It is based on the use of a 50 mm thick reference plate consisting of a carbon-fibre-reinforced polyester box. The patient is placed directly on this box, which makes the methods less cumbersome and more suitable for routine use. The method has been tested in a model experiment designed for detecting small movements between femur and prosthesis at an early stage after total hip replacement. The head and two hemispheres on the prosthesis and three small tantalum balls inserted in the femur serve as reference points. The model experiment now reported shows that the method has acceptable precision.

  • 162.
    Dogan, Sinan
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elserafy, Ahmed Taher
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Vuola, Jyrki
    Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Finland.
    Kankuri, Esko
    Department of Pharmacology, Faculty of Medicine, University of Helsinki, Finland.
    Grigoriadi, Marina Perdiki
    Region Östergötland, Center for Diagnostics, Clinical pathology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology.
    Valtonen, Jussi
    Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Finland.
    Abdelrahman, Islam
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Karlsson, Matilda
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Olofsson, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Lindford, Andrew
    Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Finland.
    A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft2022In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 21666Article in journal (Refereed)
    Abstract [en]

    To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns. Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022. © 2022, The Author(s).

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  • 163.
    Droppa, Michal
    et al.
    Univ Hosp Tubingen, Germany.
    Rudolph, Tanja K.
    Cologne Univ, Germany; Heart and Diabet Ctr NRW, Germany.
    Baan, Jan
    Univ Amsterdam, Netherlands.
    Nielsen, Niels Erik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Baumgartner, Helmut
    Univ Hosp Muenster, Germany.
    Vendrik, Jeroen
    Univ Amsterdam, Netherlands.
    Froehlich, Maren
    Inst Pharmacol and Prevent Med, Germany.
    Borst, Oliver
    Univ Hosp Tubingen, Germany.
    Woehrle, Jochen
    Univ Ulm, Germany.
    Gawaz, Meinrad
    Univ Hosp Tubingen, Germany.
    Potratz, Paul
    Univ Hosp Tubingen, Germany.
    Hack, Luis P.
    Univ Hosp Tubingen, Germany.
    Mauri, Victor
    Cologne Univ, Germany.
    Baranowski, Jacek
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bramlage, Peter
    Inst Pharmacol and Prevent Med, Germany.
    Kurucova, Jana
    Edwards Lifesci, Czech Republic.
    Thoenes, Martin
    Edwards Lifesci, Switzerland.
    Rottbauer, Wolfgang
    Univ Ulm, Germany.
    Geisler, Tobias
    Univ Hosp Tubingen, Germany.
    Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis2020In: Heart and Vessels, ISSN 0910-8327, E-ISSN 1615-2573, Vol. 35, p. 1735-1745Article in journal (Refereed)
    Abstract [en]

    Permanent pacemaker implantation (PPI) is a widely recognized complication associated with TAVI (incidence up to 20%). Smaller registries have identified several variables associated with PPI. The objective was to validate patient- and transcatheter aortic valve implantation (TAVI)-related procedural variables associated with PPI. We performed a retrospective analysis of patients from six European centers undergoing TAVI with the Edwards SAPIEN 3 prosthesis. Baseline variables and pre-procedural ECG characteristics and CT-scans were taken into account. Data for 1745 patients were collected; 191 (10.9%) required PPI after TAVI. The baseline variables pulmonary hypertension (OR 1.64; 95% CI 1.01-2.59), QRS duration &gt; 117 ms (OR 2.58; 95% CI 1.73-3.84), right bundle branch block (RBBB; OR 5.14; 95% CI 3.39-7.72), left anterior hemi block (OR 1.92; 95% CI 1.19-3.02) and first-degree atrioventricular block (AVB, OR 1.63; 95%CI 1.05-2.46) were significantly associated with PPI. RBBB (OR 8.11; 95% CI 3.19-21.86) and first-degree AVB (OR 2.39; 95% CI 1.18-4.66) remained significantly associated in a multivariate analysis. Procedure-related variables included access site (TF; OR 1.97; 95% CI 1.07-4.05), implanted valve size (29 mm; OR 1.88; 95% CI 1.35-2.59), mean TAVI valve implantation depth below the annulus &gt; 30% (OR 3.75; 95% CI 2.01-6.98). Patients receiving PPI had longer ICU stays and later discharges. Acute kidney injury stage 2/3 was more common in patients with PPI until discharge (15.2 vs. 3.1%;p = 0.007), but was not statistically significant thereafter. Further differences in outcomes at 30 days did not reach significance. The data will aid pre- and post-procedural patient management and prevent adverse long-term outcomes. Clinical Trial: NCT03497611.

  • 164.
    Dutta, Ravi Kumar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Arnesen, Thomas
    Haukeland Hosp, Norway; Univ Bergen, Norway; Univ Bergen, Norway.
    Heie, Anette
    Haukeland Hosp, Norway.
    Walz, Martin
    Klin Chirurg and Zentrum Minimal Invas Chirurg, Germany.
    Alesina, Piero
    Klin Chirurg and Zentrum Minimal Invas Chirurg, Germany.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Gimm, Oliver
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    A somatic mutation in CLCN2 identified in a sporadic aldosterone-producing adenoma2019In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 181, no 5, p. K37-K41Article in journal (Refereed)
    Abstract [en]

    Objective: To screen for CLCN2 mutations in apparently sporadic cases of aldosterone-producing adenomas (APAs). Description: Recently, CLCN2, encoding for the voltage-gated chloride channel protein 2 (CIC-2), was identified to be mutated in familial hyperaldosteronism II (FH II). So far, somatic mutations in CLCN2 have not been reported in sporadic cases of APAs. We screened 80 apparently sporadic APAs for mutations in CLCN2. One somatic mutation was identified at p.Gly24Asp in CLCN2. The male patient had a small adenoma in size but high aldosterone levels preoperatively. Postoperatively, the patient had normal aldosterone levels and was clinically cured. Conclusion: In this study, we identified a CLCN2 mutation in a sporadic APA comprising about 1% of all APAs investigated. This mutation was complementary to mutations in other susceptibility genes for sporadic APAs and may thus be a driving mutation in APA formation.

  • 165.
    Edelmann, Frank
    et al.
    Charite Univ Med Berlin, Germany; Free Univ Berlin, Germany; Humboldt Univ, Germany; Berlin Inst Hlth, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Utrecht, Netherlands.
    Comin-Colet, Josep
    Univ Barcelona, Spain.
    Schorr, Jessica
    Novartis Pharma GmbH, Germany.
    Ecochard, Laurent
    Novartis Pharma AG, Switzerland.
    Hussain, Rizwan I
    Novartis Pharma AG, Switzerland.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy; St Anna Sch Adv Studies, Italy.
    Rationale and study design ofOUTSTEP-HF: a randomised controlled study to assess the effect of sacubitril/valsartan and enalapril on physical activity measured by accelerometry in patients with heart failure with reduced ejection fraction2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 9, p. 1724-1733Article in journal (Refereed)
    Abstract [en]

    Aim In PARADIGM-HF, sacubitril/valsartan demonstrated superiority to enalapril in reducing mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Several patient-centred outcomes like improved physical activity and quality of life have been emphasised as important treatment goals in HF management. OUTSTEP-HF has been designed to evaluate the effect of sacubitril/valsartan compared with enalapril on non-sedentary daytime physical activity in patients with HFrEF. Methods OUTSTEP-HF is a randomised, actively controlled, double-blind, double-dummy study that plans to enrol 600 ambulatory patients with symptomatic HFrEF in 19 European countries. Patients will be randomised 1:1 to receive sacubitril/valsartan 97/103 mg bid or enalapril 10 mg bid. The primary objective of the study is to assess changes from baseline (Week 0) to Week 12 in exercise capacity measured by the 6-min walk test and in daily non-sedentary daytime activity. Physical activity and objective sleep parameters will be measured by accelerometry using a wrist-worn device, worn continuously from screening (Week -2) until the end of study (Week 12). As a co-primary outcome, changes from baseline in sub-maximal exercise capacity will be assessed by the 6-min walk test. Patient- and physician-reported questionnaires will be used to assess quality of life, changes in signs and symptoms of HF and sleep parameters. Conclusion OUTSTEP-HF will be the largest randomised trial in HF to date to use non-invasive accelerometry to assess whether treatment with sacubitril/valsartan improves patients daily physical activity and exercise capacity compared with enalapril.

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  • 166.
    Edholm, David
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Early intake of solid food after Roux-en-Y gastric bypass and complications. A cohort study from the Scandinavian Obesity Surgery Registry2018In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 9, p. 1256-1260Article in journal (Refereed)
    Abstract [en]

    Background: Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure worldwide. There are few studies investigating how early return to solid food affects complications. Objective: The aim of this study was to explore how oral intake was resumed in RYGB patients and how the postoperative food regimen affects outcomes, such as complications and length of stay. Setting: Retrospective nationwide registry study. Methods: The Scandinavian Obesity Surgery Registry included prospective data from RYGB patients operated in 2009 to 2014. A questionnaire assessed the postoperative reintroduction of solid food applied at each bariatric center. The postoperative regimen was established in 23,589 patients. Outcomes were recorded at 30-day follow-up according to the standard Scandinavian Obesity Surgery Registry routine. Results: Nine percent of patients (n = 2074) returned to solid food within the first week after surgery. Most commonly solid food was resumed in week 4 (37%, n=8659). Median length of stay was 2 days for all. Of all, 2.8% suffered from a severe complication (amp;gt;Clavien-Dindo 3a). After adjusting for the annual volume of procedures at hospitals, there was no correlation that the timing of solid food affected complication rates. The odds ratio for a severe complication was significantly lower for intermediate- (odds ratio .64 95% confidence interval .48.85) or high (odds ratio .52 95% confidence interval .42.66) volume centers. The rate of leaks and small bowel obstructions were evenly distributed between the different postoperative food regimens. Conclusion: Early return to solid food after RYGB did not affect the risk of severe complications. Patients operated at centers with an annual volume of amp;gt; 100 procedures have a lower risk of severe complications. (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  • 167.
    Edholm, David
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response to "Association between early intake of solid food after Roux-en-Y gastric bypass and complications"2019In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 2, p. 358-358Article in journal (Other academic)
    Abstract [en]

    n/a

  • 168.
    Edholm, David
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Systematic Review and Meta-analysis of Circular- and Linear-Stapled Gastro-jejunostomy in Laparoscopic Roux-en-Y Gastric Bypass2019In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 6, p. 1946-1953Article, review/survey (Refereed)
    Abstract [en]

    To compare circular stapler (CS) with linear stapler (LS) in a meta-analysis concerning operative time, anastomotic leaks, wound infections, strictures, and length of stay. Pubmed, Medline, and Scopus were searched for articles published since 2006. Four hundred and five articles were assessed, and 13 articles of which only one was a randomized controlled trial were included in all 49,331 patients from different regions of the world. The pooled analysis shows that operative time was shorter in LS than in CS (weighted mean difference 36.2min; 95% CI 34.7-37.6.; pamp;lt;0.0001). No difference was seen concerning leaks or strictures. The relative risk (RR) of leakage after LS was 80% of the risk after CS; however, the 95% confidence interval (CI) showed overlap (0.58-1.11). The RR of anastomotic stricture after LS was 74% of the risk after CS; however, 95% CI (0.52-1.05) showed overlap. Wound infections were less common after LS than after CS; RR was 27% (95% CI 0.21-0.33). Length of stay (LOS) was 0.65days shorter after LS than after CS (95% CI 0.51-0.78). LS compared with CS results in shorter operative time, less wound infections, and shorter length of stay, but no difference was seen concerning risks of leaks or strictures.

  • 169.
    Edholm, David
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Andersson, Roland
    Jonkoping Cty Council, Sweden.
    Frankel, Adam
    Univ Queensland, Australia.
    Esophageal perforations - a population-based nationwide study in Sweden with survival analysis2022In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 57, no 9, p. 1018-1023Article in journal (Refereed)
    Abstract [en]

    Background Esophageal perforation is a rare and life-threatening condition with several treatment options. The aim was to assess the incidence, type of treatment and mortality of esophageal perforations in Sweden and to identify risk factors for 90-day mortality. Method All patients admitted with an esophageal perforation from 2007 to 2017 were identified from the National Patient Register. Mortality was assessed by linkage with the Cause of Death Registry. We analyze the incidence and the impact of age, sex, comorbidities on mortality. Results 879 patients with esophageal perforation were identified, giving an incidence rate of 1.09 per 100,000 person-years. The median age at diagnosis was 68.8 years and 60% were men. The mortality was 26% at 90 days. Independent risk factors for death within 90 days were age (odds ratio (OR): 6.20; 95% (confidence interval) CI: 2.16-17.79 at 60-74 years and OR: 11.58; 95% CI: 4.04-33.15 at 75 years or older), peripheral vascular disease (OR: 2.92; 95% CI: 1.44-5.92) and underlying malignant disease (OR: 5.91; 95% CI: 3.86-9.03). In patients younger than 45 years, survival was lower among women than among men (at 5 years 73 and 93%, respectively). The cause of death among young women was often drug-related or suicide. Conclusions 90-day mortality was 26%, old age, vascular disease and underlying malignant disease were risk factors.

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  • 170.
    Edholm, David
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hofgård, Johan Olsson
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, Ellen
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Stenberg, Erik
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Olbers, Torsten
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Very low risk of short bowel after Roux-en-Y gastric bypass – a large nationwide Swedish cohort study2024In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 20, no 4, p. 362-366Article in journal (Refereed)
    Abstract [en]

    Background: Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome.

    Objective: To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection.

    Setting: Cohort from national quality registers.

    Methods: All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients.

    Results: The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.

  • 171.
    Edholm, David
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindblad, Mats
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Linder, Gustav
    Uppsala Univ, Sweden.
    Abandoning resectional intent in patients initially deemed suitable for esophagectomy: a nationwide study of risk factors and outcomes2021In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, Vol. 34, no 3, article id DOAA088Article in journal (Refereed)
    Abstract [en]

    The main curative treatment modality for esophageal cancer is resection. Patients initially deemed suitable for resection may become unsuitable, most commonly due to signs of generalized disease or having become unfit for surgery. The aim was to assess risk factors for abandoning esophagectomy and its impact on survival. All patients diagnosed with an esophageal or gastroesophageal junction cancer in the Swedish National Register for Esophageal and Gastric Cancer from 2006-2016 were included and risk factors associated with becoming ineligible for resection were analyzed in multivariable logistic regression analysis. Overall survival was explored by multivariable Cox regression models. Among 1,792 patients planned for resection, 189 (11%) became unsuitable for resection before surgery and 114 (6%) had exploratory surgery without resection. Intermediate and high educational levels were associated with an increased probability of resection (odds ratio (OR) 1.46, 95% CI 1.05-2.05, OR 1.92, 95% CI 1.28-2.87, respectively) as was marital status (married: OR 1.37, 95% CI 1.01-1.85). Clinically advanced disease (cT4: OR 0.38, 95% CI 0.16-0.87; cN3: OR 0.27, 95% CI 0.09-0.81) and neoadjuvant treatment were associated with a decreased probability of resection (OR 0.62, 95% CI 0.46-0.88). Five-year survival for non-resected patients was only 4.5% although neoadjuvant treatment was associated with improved survival (HR 0.75, 95% CI 0.56-0.99). Non-resected patients with squamous cell carcinoma had comparatively reduced survival (HR 1.64, 95% CI 1.10-2.43). High socioeconomic status was associated with an increased probability of completing the plan to resect whereas clinically advanced disease and neoadjuvant treatment were independent factors associated with increased risk of abandoning resectional intent.

  • 172.
    Eilard, Malin S.
    et al.
    Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Naredi, Peter
    Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Helmersson, Madeleine
    Regional Cancer Center West, Western Sweden Health Care Region, Gothenburg, Sweden.
    Hemmingsson, Oskar
    Department of Surgical and Perioperative Sciences, Umeå University, Sweden.
    Isaksson, Bengt
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Lindell, Gert
    Department of Surgery, Skåne University Hospital, Lund, Sweden.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Strömberg, Cecilia
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
    Rizell, Magnus
    Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Survival and prognostic factors after transplantation, resection and ablation in a national cohort of early hepatocellular carcinoma2021In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 23, no 3, p. 394-403Article in journal (Refereed)
    Abstract [en]

    BackgroundIn patients with early hepatocellular cancer (HCC) and preserved liver function, the choice between transplantation, resection and ablation and which factors to consider is not obvious and guidelines differ. In this national cohort study, we aimed to compare posttreatment survival in patients fulfilling predefined criteria, and to analyse preoperative risk factors that could influence decision.MethodsWe used data from HCC-patients registered with primary transplantation, resection or ablation 2008–2016 in the SweLiv-registry. In Child A-subgroups, 18–75 years, we compared survival after transplantation or resection, with different tumour criteria; either corresponding to our transplantation criteria (N = 257) or stricter with single tumours ≤50 mm (N = 159). A subgroup with single tumours ≤30 mm, compared all three treatments (N = 193).ResultsWe included 1022 HCC-patients; transplantation n = 223, resection n = 438, ablation n = 361. In the transplant criteria subgroup, differences in five-year survival, adjusted for age and gender, were not significant, with 71.2% (CI 62.3–81.3) after transplantation (n = 109) and 63.5% (CI 54.9–73.5) after resection (n = 148). Good liver function (Child 5 vs. 6, Albumin ≥36), increased the risk after transplantation, but decreased the risk after resection and ablation.ConclusionEven within Child A, detailed liver function assessment is important before treatment decision, and for stratifying survival comparisons.

  • 173.
    Ekas, Guri Ranum
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Norwegian Sch Sports Sci, Norway.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia; Karolinska Inst, Sweden.
    Grindem, Hege
    Norwegian Sch Sports Sci, Norway; Karolinska Inst, Sweden.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Norwegian Sch Sports Sci, Norway.
    Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 9, p. 520-+Article, review/survey (Refereed)
    Abstract [en]

    Objective To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. Design Prognosis systematic review (PROSPERO registration number CRD42016036788). Methods We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. Results Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%-21% when follow-up was &lt;2 years, 0%-29% when follow-up was 2 to 5 years, 5%-52% when follow-up was 5 to 10 years and 4%-31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. Conclusion New meniscal tears occurred in 0%-52% of patients between 4 months and 20 years (mean 4.9 +/- 4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.

  • 174.
    Ekholm, Maria
    et al.
    Lund University, Sweden; Ryhov County Hospital, Sweden.
    Bendahl, Par-Ola
    Lund University, Sweden.
    Ferno, Marten
    Lund University, Sweden.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Ryden, Lisa
    Lund University, Sweden.
    Two Years of Adjuvant Tamoxifen Provides a Survival Benefit Compared With No Systemic Treatment in Premenopausal Patients With Primary Breast Cancer: Long-Term Follow-Up (> 25 years) of the Phase III SBII:2pre Trial2016In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 34, no 19, p. 2232-+Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study was to evaluate the long-term effect of 2 years of adjuvant tamoxifen compared with no systemic treatment (control) in premenopausal patients with breast cancer over different time periods through long-term (amp;gt; 25 years) follow-up. Patients and Methods Premenopausal patients with primary breast cancer (N = 564) were randomly assigned to 2 years of tamoxifen (n = 276) or no systemic treatment (n = 288). Data regarding date and cause of death were obtained from the Swedish Cause of Death Register. End points were cumulative mortality (CM) and cumulative breast cancer-related mortality (CBCM). The median follow-up for the 250 patients still alive in April 2014 was 26.3 years (range, 22.7 to 29.7 years). Results In patients with estrogen receptor-positive tumors (n = 362), tamoxifen was associated with a marginal reduction in CM (hazard ratio [HR], 0.77; 95% CI, 0.58 to 1.03; P = .075) and a significant reduction in CBCM (HR, 0.73; 95% CI, 0.53 to 0.99; P = .046). The effect seemed to vary over time (CM years 0 to 5: HR, 1.05; 95% CI, 0.64 to 1.73; years amp;gt;5 to 15: HR, 0.58; 95% CI, 0.37 to 0.91; and after 15 years: HR, 0.82; 95% CI, 0.48 to 1.42; CBCM years 0 to 5: HR, 1.09; 95% CI, 0.65 to 1.82; years amp;gt;5 to 15: HR, 0.53; 95% CI, 0.33 to 0.86; and after 15 years: HR, 0.72; 95% CI, 0.36 to 1.44). Conclusion Two years of adjuvant tamoxifen resulted in a long-term survival benefit in premenopausal patients with estrogen receptor-positive primary breast cancer. (C) 2016 by American Society of Clinical Oncology. Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/

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  • 175.
    Eklund, Sanna A.
    et al.
    Umea Univ, Sweden.
    Israelsson Larsen, Hanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Carlberg, Bo
    Umea Univ, Sweden.
    Malm, Jan
    Umea Univ, Sweden.
    Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools2023In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 138, no 2, p. 476-482Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE Vascular risk factors (VRFs) may act synergistically, and clinical decision support tools (CDSTs) have been developed that present vascular risk as a summarized score. Because VRFs are a major issue in patients with idiopathic normal pressure hydrocephalus (INPH), a CDST may be useful in the diagnostic workup. The objective was to compare 4 CDSTs to determine which one most accurately predicts short-term outcome and 10-year mortality after CSF shunt surgery in INPH patients. METHODS One-hundred forty INPH patients who underwent CSF shunt surgery were included. For each patient, 4 CDST scores (Systematic Coronary Risk Evaluation-Older Persons [SCORE-OP], Framingham Risk Score [FRS], Revised Framingham Stroke Risk Profile, and Kiefers Comorbidity Index [KCI]) were estimated. Short-term outcome (3 months after CSF shunt surgery) was defined on the basis of improvements in gait, Mini-Mental State Examination score, and modified Rankin Scale score. The 10-year mortality rate after surgery was noted. The CDSTs were compared by using Cox regression analysis, receiver operating characteristic curve analysis, and the chi-square test. RESULTS For 3 CDSTs, increased score was associated with increased risk of 10-year mortality. A 1-point increase in the FRS indicated a 2% higher risk of death within 10 years (HR 1.02, 95% CI 1.003-1.035, p = 0.021); SCORE-OP, 5% (HR 1.05, 95% CI 1.019-1.087, p = 0.002); and KCI, 12% (HR 1.12, 95% CI 1.03-1.219, p = 0.008). FRS predicted short-term outcome of surgery (p = 0.024). When the cutoff value was set to 32.5%, the positive predictive value was 80% and the negative predictive value was 48% (p = 0.012). CONCLUSIONS The authors recommend using FRS to predict short-term outcome and 10-year risk of mortality in INPH patients. The study indicated that extensive treatment of the risk factors of INPH may decrease risk of mortality. Clinical trial registration no.: NCT01850914 (ClinicalTrials.gov)

  • 176. Order onlineBuy this publication >>
    Elawa, Sherif
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Microvascular Function Assessment after Mastectomy and Radiation Therapy in Breast Cancer Patients: From Methodology to Clinical Application2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Post-mastectomy radiotherapy (PMRT) is an important part of the treatment of breast cancer. It reduces the risk of recurrence and improves overall survival. Scaring and fibrotization of the skin and subcutaneous tissue of the chest wall or remaining breast are among its side-effects. These late side-effects of PMRT may in turn affect skin microcirculation and oxygenation, although this connection is not completely established. In patients that later require breast reconstruction, it is difficult as a plastic surgeon to evaluate if the microcirculatory changes have been affected by PMRT, and how such effects should have an impact on the choice of reconstructive method. In the work presented in this thesis, laser speckle contrast imaging (LSCI), laser-doppler flowmetry (LDF) and diffuse reflectance spectroscopy (DRS) have been used with a strong vasodilator, methyl nicotinate (MN) to study the microcirculatory changes after PMRT.

    In studies I and II, we aimed to find the optimal concentration of MN and its main mechanisms of action. In healthy volunteers, the microvascular response to different concentrations of MN was evaluated on the forearm using LSCI. It was found that a concentration of 20 mmol/l resulted in a quick vasodilatory response with a long plateau phase, minimal tissue edema and no non-responders. In study II, we utilized locally administered drugs to block the three main pathways responsible for skin vasodilation. Subsequently, we provoked the skin with MN and assessed its effect with LSCI. From this study we could conclude that MN’s mechanism of action is largely mediated by prostaglandins and partly by local sensory nerves.

    In study III, we examined the skin microcirculatory response in breast cancer patients before, immediately after, and at two and six months following unilateral PMRT, using the contralateral breast as a control. A significant increase in basal skin perfusion and perfusion after application of MN was observed on the irradiated chest wall immediately after RT compared to the contralateral breast and compared to before RT. At six months after RT, there was no longer a difference in basal skin perfusion or after application of MN in the irradiated chest wall compared to the contralateral breast and compared to before RT was given. The results from this study concluded that skin perfusion in the irradiated chest wall had returned to normal when measured six months after RT.

    In study IV, the late effects on skin microvascular function were studied in women who had undergone mastectomy and PMRT several years prior to the study. Skin perfusion and oxygen saturation was measured with white light diffuse reflectance spectroscopy (DRS) combined with Laser Doppler Flowmetry (LDF) before and after application of MN on the irradiated chest wall with the contralateral non-irradiated breast as control. In this study we found that skin perfusion and oxygenation in the breast are affected several years after radiotherapy and that our method could be a valuable clinical tool prior to deciding surgical procedures after PMRT.

    To conclude, MN can be topically applied to the skin to reliably assess microvascular function and the microvascular capacity. LSCI and LDF have different strengths and drawbacks, with LSCI having the advantage of having a large spatial resolution that allows for measurements of control areas in the same field of view as the provoked areas. LDF in combination with DRS enabled us to further assess perfusion and oxygenation simultaneously which could be an advantage in fibrotic skin where skin perfusion and oxygen saturation may not correlate with each other. Although the study groups differed between the study examining the early effects of PMRT with the late effects of PMRT, we have been able to non-invasively visualize changes in microcirculation in relation to the acute and chronic phase after PMRT. Future studies are needed to investigate the value of pre-operative measurements with MN provocation for predicting surgical outcome.

    List of papers
    1. The microvascular response in the skin to topical application of methyl nicotinate: Effect of concentration and variation between skin sites
    Open this publication in new window or tab >>The microvascular response in the skin to topical application of methyl nicotinate: Effect of concentration and variation between skin sites
    2019 (English)In: Microvascular Research, ISSN 0026-2862, E-ISSN 1095-9319, Vol. 124, p. 54-60Article in journal (Refereed) Published
    Abstract [en]

    Background

    Methyl nicotinate (MN) induces a local cutaneous erythema in the skin and may be used as a local provocation in the assessment of microcirculation and skin viability. The aims were to measure the effects of increasing doses of MN, to find the concentration that yields the most reproducible effect from day to day and between sites, and to study the variation between skin sites.

    Methods

    Microvascular responses to topically applied MN at different concentrations were measured in 12 subjects on separate days and on contralateral sides, using laserspeckle contrast imaging (LSCI). MN effects were measured in four different body sites.

    Results

    At 20 mmol/L, the response to MN was most reproducible day-to-day and site-to-site, and resulted in a plateau response between 5 and 20 min after application.

    The skin region of the lower back had a lower perfusion value compared to the epigastric region (p = 0.007). When responses were compared to nearby, unprovoked areas, a significantly larger increase in perfusion was seen in the forearm, compared to all other anatomical sites (p < 0.03).

    Conclusion

    A concentration of 20 mmol/L MN generated the most reproducible microvascular response in the skin. The response varies between different body sites.

    Place, publisher, year, edition, pages
    Academic Press, 2019
    National Category
    Medical Laboratory and Measurements Technologies
    Identifiers
    urn:nbn:se:liu:diva-156888 (URN)10.1016/j.mvr.2019.03.002 (DOI)000466057200009 ()30877017 (PubMedID)2-s2.0-85062903925 (Scopus ID)
    Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2024-04-29Bibliographically approved
    2. Skin blood flow response to topically applied methyl nicotinate: Possible mechanisms
    Open this publication in new window or tab >>Skin blood flow response to topically applied methyl nicotinate: Possible mechanisms
    2020 (English)In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 26, no 3, p. 343-348Article in journal (Refereed) Published
    Abstract [en]

    Background Methyl nicotinate (MN) induces a local cutaneous erythema in the skin and may be valuable as a local provocation in the assessment of microcirculation and skin viability. The mechanisms through which MN mediates its vascular effect are not fully known. The aim of this study was to characterize the vasodilatory effects of topically applied MN and to study the involvement of nitric oxide (NO), local sensory nerves, and prostaglandin-mediated pathways. Methods MN was applied on the skin of healthy subjects in which NO-mediated (L-NMMA), nerve-mediated (lidocaine/prilocaine), and cyclooxygenase-mediated (NSAID) pathways were selectively inhibited. Microvascular responses in the skin were measured using laser speckle contrast imaging (LSCI). Results NSAID reduced the MN-induced perfusion increase with 82% (P &lt; .01), whereas lidocaine/prilocaine reduced it with 32% (P &lt; .01). L-NMMA did not affect the microvascular response to MN. Conclusion The prostaglandin pathway and local sensory nerves are involved in the vasodilatory actions of MN in the skin.

    Place, publisher, year, edition, pages
    WILEY, 2020
    Keywords
    capillary capacity; laser speckle contrast imaging; methyl nicotinate; microcirculation; tissue viability
    National Category
    Medical Laboratory and Measurements Technologies
    Identifiers
    urn:nbn:se:liu:diva-165928 (URN)10.1111/srt.12807 (DOI)000531818000004 ()31777124 (PubMedID)
    Available from: 2020-06-04 Created: 2020-06-04 Last updated: 2024-04-29
    3. Microcirculatory changes in the skin after postmastectomy radiotherapy in women with breast cancer
    Open this publication in new window or tab >>Microcirculatory changes in the skin after postmastectomy radiotherapy in women with breast cancer
    Show others...
    2024 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 4149Article in journal (Refereed) Published
    Abstract [en]

    Postmastectomy radiotherapy (PMRT) increases the risk for complications after breast reconstruction. The pathophysiological mechanism underlying this increased risk is not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion in the skin directly after, and at 2 and 6 months after PMRT and to assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate-MN) after PMRT. Skin microvascular responses after PMRT were measured on two sites in the irradiated chest wall of 22 women before, immediately after, and at 2 and 6 months after unilateral PMRT with the contralateral breast as a control. A significant increase in basal skin perfusion was observed in the irradiated chest wall immediately after RT (p < 0.0001). At 2 and 6 months after RT, there was no longer a difference in basal skin perfusion compared to the contralateral breast and compared to baseline. Similarly, the blood flow response in the skin after application of MN was stronger immediately after RT compared to before RT (p < 0.0001), but there was no difference at later time points. These results indicate that the increased risk for complications after surgical procedures are not directly related to changes in skin perfusion and microvascular responsiveness observed after postmastectomy RT.

    Place, publisher, year, edition, pages
    Nature Publishing Group, 2024
    National Category
    Cancer and Oncology Surgery
    Identifiers
    urn:nbn:se:liu:diva-201656 (URN)10.1038/s41598-024-54650-4 (DOI)001173675500030 ()38378732 (PubMedID)2-s2.0-85185473058 (Scopus ID)
    Note

    Funding: Linköping University

    Available from: 2024-03-17 Created: 2024-03-17 Last updated: 2024-04-29Bibliographically approved
    4. Skin perfusion and oxygen saturation after mastectomy and radiation therapy in breast cancer patients
    Open this publication in new window or tab >>Skin perfusion and oxygen saturation after mastectomy and radiation therapy in breast cancer patients
    Show others...
    2024 (English)In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 75, article id 103704Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    The pathophysiological mechanism behind complications associated with postmastectomy radiotherapy (PMRT) and subsequent implant-based breast reconstruction are not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion and saturation in the skin after mastectomy and assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate - MN). Skin microvascular perfusion and oxygenation >2 years after PMRT were measured using white light diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LDF) in the irradiated chest wall of 31 women with the contralateral breast as a control. In the non-irradiated breast, the perfusion after application of MN (median 0.84, 25th-75th centile 0.59-1.02 % RBC × mm/s) was higher compared to the irradiated chest wall (median 0.51, 25th-75th centile 0.21-0.68 % RBC × mm/s, p < 0.001). The same phenomenon was noted for saturation (median 91 %, 25th-75th centile 89-94 % compared to 89 % 25th-75th centile 77-93 %, p = 0.001). Eight of the women (26%) had a ≥10 % difference in skin oxygenation between the non-irradiated breast and the irradiated chest wall. These results indicate that late microvascular changes caused by radiotherapy of the chest wall significantly affect skin perfusion and oxygenation.

    Place, publisher, year, edition, pages
    Elsevier, 2024
    National Category
    Cancer and Oncology Surgery
    Identifiers
    urn:nbn:se:liu:diva-201655 (URN)10.1016/j.breast.2024.103704 (DOI)001216488000001 ()38460441 (PubMedID)2-s2.0-85186992326 (Scopus ID)
    Available from: 2024-03-17 Created: 2024-03-17 Last updated: 2024-05-22Bibliographically approved
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  • 177.
    Elawa, Sherif
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredriksson, Ingemar
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Perimed AB, Järfälla, Stockholm, Sweden.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Zötterman, Johan
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Farnebo, Simon
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Droog Tesselaar, Erik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics.
    Skin perfusion and oxygen saturation after mastectomy and radiation therapy in breast cancer patients2024In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 75, article id 103704Article in journal (Refereed)
    Abstract [en]

    The pathophysiological mechanism behind complications associated with postmastectomy radiotherapy (PMRT) and subsequent implant-based breast reconstruction are not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion and saturation in the skin after mastectomy and assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate - MN). Skin microvascular perfusion and oxygenation >2 years after PMRT were measured using white light diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LDF) in the irradiated chest wall of 31 women with the contralateral breast as a control. In the non-irradiated breast, the perfusion after application of MN (median 0.84, 25th-75th centile 0.59-1.02 % RBC × mm/s) was higher compared to the irradiated chest wall (median 0.51, 25th-75th centile 0.21-0.68 % RBC × mm/s, p < 0.001). The same phenomenon was noted for saturation (median 91 %, 25th-75th centile 89-94 % compared to 89 % 25th-75th centile 77-93 %, p = 0.001). Eight of the women (26%) had a ≥10 % difference in skin oxygenation between the non-irradiated breast and the irradiated chest wall. These results indicate that late microvascular changes caused by radiotherapy of the chest wall significantly affect skin perfusion and oxygenation.

  • 178.
    Elawa, Sherif
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Myrelid, Pär
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Zdolsek, Johann
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Intestinal obstruction following harvest of VRAM-flap for reconstruction of a large perineal defect2015In: Case Reports in Plastic Surgery and Hand Surgery, ISSN 2332-0885, Vol. 2, no 3-4, p. 88-91Article in journal (Refereed)
    Abstract [en]

    A patient with locally advanced adenocarcinoma of the rectum was operated with abdominoperineal resection and perineal reconstruction with a vertical rectus abdominis musculocutaneous flap. Six days postoperatively, there was herniation of the small bowel, between the anterior and posterior rectus sheaths, to a subcutaneous location.

  • 179.
    Elawa, Sherif
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Mirdell, Robin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Stefanis, Aristotelis
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Droog Tesselaar, Erik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics.
    Farnebo, Simon
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Microcirculatory changes in the skin after postmastectomy radiotherapy in women with breast cancer2024In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 4149Article in journal (Refereed)
    Abstract [en]

    Postmastectomy radiotherapy (PMRT) increases the risk for complications after breast reconstruction. The pathophysiological mechanism underlying this increased risk is not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion in the skin directly after, and at 2 and 6 months after PMRT and to assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate-MN) after PMRT. Skin microvascular responses after PMRT were measured on two sites in the irradiated chest wall of 22 women before, immediately after, and at 2 and 6 months after unilateral PMRT with the contralateral breast as a control. A significant increase in basal skin perfusion was observed in the irradiated chest wall immediately after RT (p < 0.0001). At 2 and 6 months after RT, there was no longer a difference in basal skin perfusion compared to the contralateral breast and compared to baseline. Similarly, the blood flow response in the skin after application of MN was stronger immediately after RT compared to before RT (p < 0.0001), but there was no difference at later time points. These results indicate that the increased risk for complications after surgical procedures are not directly related to changes in skin perfusion and microvascular responsiveness observed after postmastectomy RT.

  • 180.
    El-Hussuna, Alaa
    et al.
    Aalborg Univ Hosp, Denmark.
    Rubio-Perez, Ines
    Cirujano Gen Hosp Univ La Paz, Spain.
    Millan, Monica
    Hosp Univ & Politecn La Fe, Spain.
    Pellino, Gianluca
    Vall dHebron Barcelona Hosp, Italy.
    Negoi, Ionut
    Carol Davila Univ Med & Pharm Bucharest, Romania.
    Gallo, Gaetano
    Magna Graecia Univ Catanzaro, Italy.
    Shalaby, Mostafa
    Mansoura Univ, Egypt.
    Celentano, Valerio
    Univ Portsmouth, England.
    Green, Ryan
    Exter Hosp, England.
    Minaya-Bravo, Ana
    Henares Hosp, Spain.
    Emile, Sameh
    Mansoura Univ, Egypt.
    Smart, Neil J.
    Exter Hosp, England.
    Maeda, Yasuko
    Western Gen Hosp Harrow, England.
    Ivatury, Srinivas J.
    Dartmouth Hitchock Hosp, NH USA.
    Mackenzie, Graham
    Penicuik Med Practice, Scotland.
    Yalcinkaya, Ali
    Gazi Univ, Turkey.
    Mellenthin, Claudia
    Univ Fribourg, Switzerland; Univ Freiburg, Switzerland.
    N. Dudi-Venkata, Nagendra
    Univ Adelaide, Australia.
    Davies, Justin
    Univ Cambridge, England.
    McNair, Angus
    Univ Bristol, England.
    Pata, Francesco
    Giannettsio Hosp ASP Cosenza, Italy.
    Gymoese Berthelsen, Kasper
    Aalborg Univ Hosp, Denmark.
    Rivadeneira, David
    Huntigton Hosp Northwest Hlth Syst, NY USA.
    Spinelli, Antonino
    Humanitas Res Hosp, Italy.
    Myrelid, Pär
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Mayol, Julio
    Univ Complutense Madrid, Spain.
    Wexner, Steven
    Clevland Clin, FL USA.
    Patient-Reported Outcome Measures in Colorectal Surgery: Construction of Core Measures Using Open-Source Research Method2021In: Surgical Innovation, ISSN 1553-3506, E-ISSN 1553-3514, Vol. 28, no 5, p. 560-566Article in journal (Refereed)
    Abstract [en]

    Purpose. The primary aim of the study was to review the existing literature about patient-reported outcome measures (PROMs) in colorectal cancer and IBD. The secondary aim was to present a road map to develop a core outcome set via opinion gathering using social media. Method. This study is the first step of a three-step project aimed at constructing simple, applicable PROMs in colorectal surgery. This article was written in a collaborative manner with authors invited both through Twitter via the #OpenSourceResearch hashtag. The 5 most used PROMs were presented and discussed as slides/images on Twitter. Inputs from a wide spectrum of participants including researchers, surgeons, physicians, nurses, patients, and patients organizations were collected and analyzed. The final draft was emailed to all contributors and 6 patients representatives for proofreading and approval. Results. Five PROM sets were identified and discussed: EORTC QLQ-CR29, IBDQ short health questionnaire, EORTC QLQ-C30, ED-Q5-5L, and Short Form-36. There were 315 tweets posted by 50 tweeters with 1458 retweets. Awareness about PROMs was generally limited. The general psycho-physical well-being score (GPP) was suggested and discussed, and then a survey was conducted in which more than 2/3 of voters agreed that GPP covers the most important aspects in PROMs. Conclusion. Despite the limitations of this exploratory study, it offered a new method to conduct clinical research with opportunity to engage patients. The general psycho-physical well-being score suggested as simple, applicable PROMs to be eventually combined procedure-specific, disease-specific, or symptom-specific PROMs if needed.

  • 181.
    Eliasson, Pernilla T.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Agergaard, Anne-Sofie
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark; Bispebjerg Frederiksberg Hosp, Denmark.
    Couppe, Christian
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark; Bispebjerg Frederiksberg Hosp, Denmark.
    Svensson, Rene
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Hoeffner, Rikke
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark; Bispebjerg Frederiksberg Hosp, Denmark.
    Warming, Susan
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark; Bispebjerg Frederiksberg Hosp, Denmark.
    Warming, Nichlas
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Holm, Christina
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Jensen, Mikkel Holm
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Krogsgaard, Michael
    Bispebjerg Frederiksberg Hosp, Denmark; Bispebjerg Frederiksberg Hosp, Denmark.
    Kjaer, Michael
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Magnusson, S. Peter
    Bispebjerg Frederiksberg Hosp, Denmark; Univ Copenhagen, Denmark; Univ Copenhagen, Denmark; Bispebjerg Frederiksberg Hosp, Denmark.
    The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial2018In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 46, no 10, p. 2492-2502Article in journal (Refereed)
    Abstract [en]

    Background: Treatment strategies for Achilles tendon rupture vary considerably, and clinical outcome may depend on the magnitude of tendon elongation after surgical repair. The aim of this project was to examine whether tendon elongation, mechanical properties, and functional outcomes during rehabilitation of surgically repaired acute Achilles tendon ruptures were influenced by different rehabilitation regimens during the early postsurgical period. Hypothesis: Restricted early weightbearing that permits only limited motion about the ankle in the early phase of tendon healing limits tendon elongation and improves functional outcome. Study Design:Randomized controlled trial; Level of evidence, 1. Methods: 75 consecutive patients with an acute Achilles tendon rupture were included. They underwent surgical repair, and tantalum beads were placed in the distal and proximal parts of the tendon; thereafter, the patients were randomized into 3 groups. The first group was completely restricted from weightbearing until week 7. The second group was completely restricted from weightbearing until week 7 but performed ankle joint mobilization exercises. The first and second groups were allowed full weightbearing after week 8. The third group was allowed partial weightbearing from day 1 and full weightbearing from week 5. All patients received the same instructions in home exercise guidelines starting from week 9. Results: The rehabilitation regimen in the initial 8 weeks did not significantly influence any of the measured outcomes including tendon elongation. Achilles tendon elongation and tendon compliance continued for up to 6 months after surgery, and muscle strength, muscle endurance, and patient-reported functional scores did not reach normal values at 12 months. Conclusion: Differences in rehabilitation loading pattern in the initial 8 weeks after the repair of an Achilles tendon rupture did not measurably alter the outcome. The time to recover full function after an Achilles tendon rupture is at least 12 months.

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  • 182.
    Ellabban, Mohamed A.
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic and Reconstructive Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Abdelrahman, Islam
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Abdel Kader, Ghada
    Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Gomaa, Amr A.
    Plastic and Reconstructive Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Abdel Fattah, Islam Omar
    Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Egypt.
    Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival.2022In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 20891Article in journal (Refereed)
    Abstract [en]

    Beneficial effects could be achieved by various agents such as nitroglycerin, botulinum toxin A (BoTA), and clopidogrel to improve skin flap ischaemia and venous congestion injuries. Eighty rats were subjected to either arterial ischaemia or venous congestion and applied to a bipedicled U-shaped superficial inferior epigastric artery (SIEA) flap with the administration of nitroglycerin, BoTA, or clopidogrel treatments. After 7 days, all rats were sacrificed for flap evaluation. Necrotic area percentage was significantly minimized in flaps treated with clopidogrel (24.49%) versus the ischemic flaps (34.78%); while nitroglycerin (19.22%) versus flaps with venous congestion (43.26%). With ischemia, light and electron microscopic assessments revealed that nitroglycerin produced degeneration of keratinocytes and disorganization of collagen fibers. At the same time, with clopidogrel administration, there was an improvement in the integrity of these structures. With venous congestion, nitroglycerin and BoTA treatments mitigated the epidermal and dermal injury; and clopidogrel caused coagulative necrosis. There was a significant increase in tissue gene expression and serum levels of vascular endothelial growth factor (VEGF) in ischemic flaps with BoTA and clopidogrel, nitroglycerin, and BoTA clopidogrel in flaps with venous congestion. With the 3 treatment agents, gene expression levels of tumor necrosis factor-α (TNF-α) were up-regulated in the flaps with ischemia and venous congestion. With all treatment modalities, its serum levels were significantly increased in flaps with venous congestion and significantly decreased in ischemic flaps. Our analyses suggest that the best treatment option for ischemic flaps is clopidogrel, while for flaps with venous congestion are nitroglycerin and BoTA.

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  • 183.
    Ellabban, Mohamed A.
    et al.
    Suez Canal Univ, Egypt.
    Elsayed, Malek A.
    Suez Canal Univ, Egypt.
    Zein, Abo Bakr
    Cairo Univ, Egypt.
    Ghorab, Mohamed
    Cairo Univ, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Masadeh, Suhail
    Univ Cincinnati, OH 45267 USA.
    Abo-Ella, Mohamed Mokhtar
    Ain Shams Univ, Egypt.
    Sadek, Ahmed Fathy
    Minia Univ, Egypt.
    Virtual planning of the anterolateral thigh free flap for heel reconstruction2022In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 42, no 5, p. 460-469Article in journal (Refereed)
    Abstract [en]

    Purpose three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction. Patients and methods a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm(3). Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery. Results Six patients received thinned ALT (mean size = 139 cm(3)) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm(3)). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69-86). All patients regained their walking capability. Conclusions 3-D virtual planning of complex heel defects facilitates covering non-elliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility.

  • 184.
    Ellabban, Mohamed A.
    et al.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Ibrahim, Ahmed M.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Gomah, Amr A.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Salah, Omar
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Abdelrahman, Islam
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Adly, Osama A.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Aboelnaga, Ahmed M.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Assessment of Freestyle Local Facial Perforator Flaps for Coverage of Facial Defects2021In: The Journal of Craniofacial Surgery, ISSN 1049-2275, E-ISSN 1536-3732, Vol. 32, no 2, p. e122-e125Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess local freestyle facial perforator flaps in the reconstruction of small to medium-sized facial defects.

    MATERIALS AND METHODS: In a case series, local freestyle perforator flaps were used in Suez Canal University Hospital to reconstruct 28 facial defects in 26 patients between 2017 and 2019. Adequate perforators were identified near those defects and flaps were designed as propeller or VY advancement. Four scales from the FACE-Q (satisfaction with facial appearance, satisfaction with the outcome, psychological function, and appearance-related psychosocial distress) and 2 scales from the SCAR-Q (Appearance scale and Symptom scale) were used as well as the observer part of the Patient and Observer Scar Assessment Scale. The mean follow up period was 10 months.

    RESULTS: Complete reconstruction was achieved in all cases with a high rate of patient satisfaction which was assessed by FACE-Q and SCAR-Q. Moreover, observer assessment by Patient and Observer Scar Assessment Scale score showed high patient satisfaction with the scars with a mean (SD) 15.5 (3.4) and there was a positive correlation between subjective and objective: results (r2 from 0.27 to 0.41, P < 0.01). Regarding complications, bulkiness occurred in 2 flaps, congestion in 2 flaps, dehiscence in 1 flap, and tip necrosis in 5 flaps. Accordingly, secondary intervention in the form of medicinal leech therapy was used in 3 flaps, delayed closure for the dehisced flap and debulking for 1 flap.

    CONCLUSIONS: Local freestyle perforator flap reconstruction is one of the recommended techniques for small to medium-sized facial defects which gives a high aesthetic outcome and patient satisfaction.

  • 185.
    Ellabban, Mohamed A.
    et al.
    Plastic and Reconstructive Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Wyckman, Alexander
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Abdelrahman, Islam
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap2021In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, no 1, article id e3376Article in journal (Refereed)
    Abstract [en]

    Background: The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer. Methods: A retrospective analysis of 18 patients who had a dual coverage of complex wounds of the lumbar and the gluteal areas was conducted. Different propeller flaps were used as superior gluteal artery perforator flap (SGAP), inferior gluteal artery perforator flap (IGAP), and posterior thigh perforator flap (PTP). Results: The study included 15 men and 3 women. The mean age was 26.3 years. The causes of the defects were: pressure ulcers in 14 patients and post-traumatic in 4 patients. A total of 28 freestyle flaps was used: 11 patients had 1 flap, 4 had 2 flaps, and 3 had 3 flaps. The mean postoperative follow-up was 12.2 months. The complications registered in the medical records were venous congestion in 2 patients, partial flap necrosis in 2 patients, and wound dehiscence in 1 patient. Conclusions: A freestyle propeller perforator-based flap combined with a gluteus maximus muscle flap is a solution that provides well-padding over bony prominence with a low complication rate. However, a long-term follow-up is needed to verify these results. Published online 26 January 2021. Received for publication October 7, 2020; accepted November 23, 2020. Disclosure: The authors have no financial interest to declare in relation to the content of this article. Mohamed A. Ellabban, MSc, MRCS, MD, FEBOPRAS Plastic and Reconstructive Surgery Unit Surgery Department Faculty of Medicine Suez Canal University Ismailia, Egypt E-mail: Mohamed.ellabban@med.suez.edu.eg This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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  • 186.
    Elmasry, Moustafa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Abbas, A.H.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Adly, O.A.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Abdelrahman, Islam
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nagi, M.A.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Sjöberg, Folke
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Scald management protocols - outcome differences in two different time periods using different treatment strategies.2016In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, no 2, p. 139-143Article in journal (Refereed)
    Abstract [en]

    Over the years the treatment of scalds in our centre has changed, moving more towards the use of biological dressings (xenografts). Management of scalds with mid dermal or deep dermal injuries differs among centers using different types of dressings, and recently biological membrane dressings were recommended for this type of injury. Here we describe differences in treatment outcome in different periods of time. All patients with scalds who presented to the Linkoping Burn Centre during two periods, early (1997-98) and later (2010-12) were included. Data were collected in the unit database and analyzed retrospectively. A lower proportion of autograft operations was found in the later period, falling from 32% to 19%. Hospital stay was shorter in the later period (3.5 days shorter, p=0.01) and adjusted duration of hospital stay/TBSA% was shorter (1.2 to 0.7, p=0.07). The two study groups were similar in most of the studied variables: we could not report any significant differences regarding outcome except for unadjusted duration of hospital stay. Further studies are required to investigate functional and aesthetic outcome differences between the treatment modalities.

  • 187.
    Elmasry, Moustafa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Abdelrahman, Islam
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Department of Surgery, Suez Canal University, Ismailia, Egypt.
    Olofsson, Pia
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.2017In: International journal of burns and trauma, ISSN 2160-2026, Vol. 7, no 1, p. 6-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%).

    METHODS: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group).

    RESULTS: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups.

    CONCLUSION: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome.

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  • 188.
    Elmasry, Moustafa
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Thorfinn, Johan
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Olofsson, Pia
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Abbas, A.H.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Abdelrahman, Islam
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Adly, O.A.
    Plastic Surgery Unit, Department of Surgery, Suez Canal University, Egypt.
    Sjöberg, Folke
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft2016In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, no 3, p. 196-201Article in journal (Refereed)
    Abstract [en]

    During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.

  • 189.
    Eneling, Johanna
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Karlsson, Per M.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Rossitti, Sandro
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sphenopalatine arteriovenous fistula complicating transsphenoidal pituitary surgery: A rare cause of delayed epistaxis treatable by endovascular embolization.2016In: Surgical Neurology International, ISSN 2229-5097, E-ISSN 2152-7806, Vol. 7, no Suppl 41, p. S1053-S1056Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Vascular injuries in transsphenoidal surgery for pituitary adenomas are uncommon but can result in serious disability or death.

    CASE DESCRIPTION:

    A 46-year-old man, who underwent resection of a pituitary adenoma with suprasellar extension via a transsphenoidal approach, presented with massive epistaxis five days postoperatively. Angiography revealed an arteriovenous fistula (AVF) between the right sphenopalatine artery and a deep vein draining to the right internal jugular vein, as well as contrast agent extravasation at the fistula point. The AVF was catheterized and successfully occluded with N-butyl-2-cyanoacrylate.

    CONCLUSIONS:

    Transsphenoidal pituitary surgery can be complicated by massive epistaxis from a lesion of a small branch of the external carotid artery. Airway protection through intubation and investigation with conventional digital subtraction angiography is recommended. The treatment of choice is endovascular embolization because it can be done immediately at the angiography suite.

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  • 190. Order onlineBuy this publication >>
    Engstrand, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hand function in patients with Dupuytren’s disease: Assessment, results & patients’ perspectives2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Dupuytren’s Disease (DD) is a soft tissue disorder that leads to finger joint contractures affecting hand function. DD can be treated with surgery or injection and hand therapy to improve finger joint extension and thereby improve hand function. However, this does not cure the disease and recurrence is common. Previous research on DD has shown improvement in finger joint extension and in self-reported disability of the upper extremity after surgery and hand therapy for DD. However, this provides only a limited perspective on hand function, and multiple dimensions of changes in hand function (i.e. physical, psychosocial aspects and including the patients’ views of results) have not been reported as a whole.

    Aim: The overall aim of the thesis was to explore hand function before and after surgery and hand therapy in patients with DD, including assessment, results and patients’ perspectives.

    Methods: The thesis comprises three studies: Study A was a methodological study of interrater reliability in goniometry of the finger joints. Study B was a prospective cohort study with a repeated measures design. Study C was a qualitative interview study, using the model of Patient Evaluation Process and content analysis.

    Results: Interrater reliability was high or very high for goniometer measurement of finger joint range of motion (ROM) in patients with DD when experienced raters follow our standardized guidelines developed for the study. Changes in hand function consisted of improvement of finger joint extension while active finger flexion was significantly impaired during the first year after surgery and hand therapy. No patient reached a normal ROM, but the majority reached a functional ROM. Sensibility remained unaffected. Patients with surgery on multiple fingers had worse scar pliability than patients with surgery on a single finger. Most patients had their expectations met and were pleased or delighted with their hand function at 12 months after surgery and hand therapy. Safety issues of hand function were of greater concern than social issues. Patients reported less disability and improved health-related quality of life after surgery and hand therapy. The three variables “need to take special precautions”, “avoid using the hand in social context”, and health-related quality of life had significant importance for patients’ rating of functional recovery. Together, these variables explained 62% of the variance in functional recovery. Patients’ perspectives of undergoing a surgical intervention process were described through five categories. Previous experiences of care influenced participants’ expectations of results and the care they were about to receive. Previous experiences and expectations were used as references for appraisal of results, which concerned perceived changes in hand function, the care process, competency, and organization. Appraisal of results could also vary in relation to  patient character. Appraisal of results of the intervention process influenced participants’ expectations of future hand function, health and care.

    Conclusions: Surgery and hand therapy for DD improve hand function and patients regain a functional ROM needed for performance of common daily activities. Despite the negative effect on finger flexion present during the first year after surgery, patients’ regards their hand function as recovered six to eight months after surgery and hand therapy. Measuring digital ROM in the finger joints with a goniometer is a reliable assessment method. However, from the patient’s perspective, it is not enough to evaluate results only in terms of digital extension or ROM. From their view, results of treatment concern consequences on daily use of the hand, what happens during the care process in terms of interaction between patient and health care provider, as well as their view of the competence and logistics of the organization providing the care.

    List of papers
    1. Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytrens Disease
    Open this publication in new window or tab >>Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytrens Disease
    2012 (English)In: American Journal of Occupational Therapy, ISSN 0272-9490, E-ISSN 1943-7676, Vol. 66, no 1, p. 98-103Article in journal (Refereed) Published
    Abstract [en]

    We investigated interrater reliability of range of motion (ROM) measurement in the finger joints of people with Dupuytrens disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytrens disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was andlt;= 3 degrees for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytrens disease.

    Place, publisher, year, edition, pages
    American Occupational Therapy Association, 2012
    Keywords
    arthrometry, articular, Dupuytren contracture, finger joint, range of motion, articular, reproducibility of results
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-75284 (URN)10.5014/ajot.2012.001925 (DOI)000299362000012 ()
    Available from: 2012-02-27 Created: 2012-02-24 Last updated: 2021-12-29
    2. Hand function and quality of life before and after fasciectomy for Dupuytren contracture
    Open this publication in new window or tab >>Hand function and quality of life before and after fasciectomy for Dupuytren contracture
    2014 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 39, no 7, p. 1333-1343Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE:

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease.

    METHODS:

    This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.

    RESULTS:

    The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time.

    CONCLUSIONS:

    After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Dupuytren contracture; surgical treatment; range of motion; satisfaction; occupational therapy
    National Category
    Clinical Medicine Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-109387 (URN)10.1016/j.jhsa.2014.04.029 (DOI)000338905000014 ()24969497 (PubMedID)
    Available from: 2014-08-15 Created: 2014-08-15 Last updated: 2021-12-29Bibliographically approved
    3. Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease
    Open this publication in new window or tab >>Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease
    2015 (English)In: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 28, no 3, p. 255-260Article in journal (Refereed) Published
    Abstract [en]

    Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). Results: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Discussion: Safety and social issues of hand function and quality of life had an evident association with functional recovery. Level of evidence: IV.

    Place, publisher, year, edition, pages
    Elsevier, 2015
    Keywords
    Dupuytrens contracture; Emotional function; Range of motion; Recovery of function; Quality of life
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-121325 (URN)10.1016/j.jht.2014.11.006 (DOI)000359329100005 ()25998546 (PubMedID)
    Note

    Funding Agencies|Medical Research Council of southeast Sweden [FORSS-72231]; County Council of Ostergotland, Sweden [LIO-77311]

    Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2021-12-29
    4. Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results
    Open this publication in new window or tab >>Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results
    2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 24-26, p. 2538-2549Article in journal (Refereed) Published
    Abstract [en]

    Purpose To explore patients’ perspectives on surgical intervention for Dupuytren’s disease (DD), focusing on patients’ appraisal of results, involving previous experiences, expectations and patient characters.

    Method The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2–4 weeks before surgery and 6–8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis.

    Results Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants’ expectations, and these were used along with other aspects as references for appraisal of results. Participants’ appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants’ expectations of future hand function, health and care.

    Conclusions Patients’ appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care.

    Implications for Rehabilitation

    • To improve health care services, it is important to be aware of the role played by patient’s previous experiences, expectations as well as staff and organizational aspects of care.
    • Knowledge about patients’ experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care.
    • Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care.
    • Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process.
    • Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.
    Keywords
    Care process; hand function; hand surgery; interviews; outcome
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy Nursing Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-125964 (URN)10.3109/09638288.2015.1137981 (DOI)000385478900020 ()26878688 (PubMedID)
    Note

    Funding agencies: County Council of Ostergotland, Sweden

    Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2021-12-29Bibliographically approved
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  • 191.
    Engstrand, Jennie
    et al.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Sterner, Johanna
    Danderyd Hosp, Sweden.
    Hasselgren, Kristina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Stromberg, Cecilia
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Sturesson, Christian
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Treatment intention and outcome in patients with simultaneously diagnosed liver and lung metastases from colorectal cancer2022In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 48, no 8, p. 1799-1806Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to assess the likelihood of patients with simultaneously diagnosed liver and lung metastases (SLLM) from colorectal cancer (CRC) to receive the curative treatment decided upon multidisciplinary team meeting (MDT) and to elaborate on the reasons for treatment intention failure and survival outcomes depending on final treatment strategy.Method: The study included a retrospective review of all patients discussed at the MDT at a single centre between 2010 and 2018 to identify all patients presenting with SLLM from CRC. Treatment intention, actual treatment outcome and reasons for treatment failure was documented. Descriptive and survival statistics were applied.Results: Of the 160 patients who had SLLM, resection of all metastatic sites was deemed possible in 107 patients (67%) of whom 39 patients (36%) finalized the curative treatment plan. The most common reason for noncompliance with management recommendations was disease progression or recurrence. Complete resection resulted in longer survival compared to patients who did not undergo resection of all metastatic sites with median survival of 63 and 27 months, respectively (p &lt; 0.001).Conclusion: A low proportion of patients completed the initially intended curative resections. Simulta-neous resection of liver/lung metastases and primary tumour might increase the proportion of fulfilled hepatopulmonary resections.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 192.
    Enne, Marcelo
    et al.
    Ipanema Federal Hospital, Brazil.
    Schadde, Erik
    Cantonal Hospital Winterthur, Switzerland; Rush University, IL 60612 USA.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Hernandez Alejandro, Roberto
    University of Rochester, NY USA.
    Steinbruck, Klaus
    Bonsucesso Federal Hospital, Brazil.
    Viana, Eduardo
    Ipanema Federal Hospital, Brazil.
    Robles Campos, Ricardo
    Virgen Arrixaca University Hospital, Spain.
    Malago, Massimo
    Royal Free Hospital, England.
    Clavien, Pierre-Alain
    University of Zurich Hospital, Switzerland.
    De Santibanes, Eduardo
    Hospital Italiano Buenos Aires, Argentina.
    Gayet, Brice
    Institute Mutualiste Montsouris, France.
    ALPPS as a salvage procedure after insufficient future liver remnant hypertrophy following portal vein occlusion2017In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 19, no 12, p. 1126-1129Article in journal (Refereed)
    Abstract [en]

    Background: A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure. Methods: A retrospective analysis of patients enrolled within the international ALPPS Registry between October 2012 and November 2015 (NCT01924741) was performed. Patients with documented PVO failure were included. The outcomes reported included feasibility, FLR growth rate and safety of ALPPS. Complications were recorded as per Clavien-Dindo classification. Results: From 510 patients enrolled in the Registry there were 22 patients with previous PVO failure. Two patients were excluded due to missing data and twenty patients were analysed. All of them completed the proposed ALPPS with a medium FLR increase of 88% (23-115%) between two stages and no 90-day mortality. Conclusion: In experienced centers, ALPPS following PVO failure is feasible and safe. The FLR hypertrophy was similar to other ALPPS series. ALPPS is a potential rescue strategy after PVO failure.

  • 193.
    Eriksson, Kerstin
    et al.
    Jonkoping Univ, Sweden; Ryhov Cty Hosp, Sweden.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Kalmar Cty Council, Sweden.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Wikstrom, Lotta
    Jonkoping Univ, Sweden; Ryhov Cty Hosp, Sweden.
    Nausea intensity as a reflector of early physical recovery after surgery2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 5, p. 989-999Article in journal (Refereed)
    Abstract [en]

    Aim To compare different levels of self-rated average nausea intensity with early physical recovery and determine if nausea can reflect recovery in patients undergoing general or orthopaedic surgery. Background Nausea has been found to influence postoperative physical recovery. Despite the incidence of nausea in postoperative care, there is a knowledge gap about the possibility of using average nausea intensity to reflect recovery, motivating further investigation. Design An observational design with repeated measures. Methods General and orthopaedic patients answered a questionnaire (October 2012-January 2015) about nausea and impact on recovery on postoperative days 1 (N = 479) and 2 (N = 441). Questions about average nausea intensity at rest and during activity were answered based on the Numeric Rating Scale (NRS) (0-10). Impact on recovery was evaluated using three dimensions from the postoperative recovery profile tool. Results About one-fifth of the patients reported nausea intensity as moderate to severe on days 1 and 2. Nausea intensity was associated with eight of nine aspects of recovery on postoperative day 1. Nausea intensity on day 1 also reflected four of nine aspects of recovery on day 2. About reflecting physical recovery, the association was strongest between nausea intensity and appetite changes. Conclusions As postoperative nausea is common, regular assessments by healthcare professionals are needed. Assessment of nausea is of importance since it reflects physical recovery. This also shows the importance of treating nausea without delay. Using the NRS to measure nausea intensity is a simple method that is easy to use in clinic.

  • 194.
    Erlandsson, Helen
    et al.
    Karolinska Inst, Sweden.
    Qureshi, Abdul Rashid
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Scholz, Tim
    Uppsala Univ Hosp, Sweden.
    Lundgren, Torbjorn
    Karolinska Inst, Sweden.
    Bruchfeld, Annette
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Nephrology. Karolinska Inst, Sweden.
    Stenvinkel, Peter
    Karolinska Inst, Sweden.
    Wennberg, Lars
    Karolinska Inst, Sweden.
    Lindner, Per
    Univ Gothenburg, Sweden.
    Observational study of risk factors associated with clinical outcome among elderly kidney transplant recipients in Sweden - a decade of follow-up2021In: Transplant International, ISSN 0934-0874, E-ISSN 1432-2277, Vol. 34, no 11, p. 2363-2370Article in journal (Refereed)
    Abstract [en]

    Kidney transplantation (Ktx) in elderly has become increasingly accepted worldwide despite their higher burden of comorbidities. We investigated important risk factors affecting long-term patient and graft survival. We included all (n = 747) Ktx patients &gt;60 years from 2000 to 2012 in Sweden. Patients were age-stratified, 60-64, 65-69 and &gt;70 years. Follow-up time was up to 10 years (median 7.9 years, 75% percentile &gt;10 years). Primary outcome was 10-year patient survival in age-stratified groups. Secondary outcomes were 5-year patient and graft survival in age-stratified groups and the impact of risk factors including Charlson comorbidity index (CCI) on patient and graft survival. Mortality was higher in patients &gt;70 years, after 10 years (HR 1.94; 95% CI 1.24-3.04; P = 0.004). Males had a higher 10-year risk of death (HR 1.39; CI 95% 1.04-1.86; P = 0.024). Five-year patient survival did not differ between age groups. In multivariate Cox analysis (n = 500), hazard ratio for 10-year mortality was 4.6 in patients with CCI &gt;= 7 vs. &lt;4 (95% CI 2.42-8.62; P = 0.0001). Higher CCI identified ESKD patients with 4.6 times higher risk of death after Ktx. We suggest that this index should be used as a part of the preoperative evaluation in elderly.

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  • 195.
    Erlandsson, Johan
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Holm, Torbjörn
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Pettersson, David
    Karolinska Institute, Sweden; Norrtalje Hospital, Sweden.
    Berglund, Åke
    Uppsala University, Sweden.
    Cedermark, Björn
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Radu, Calin
    Uppsala University, Sweden.
    Johansson, Hemming
    Karolinska Institute, Sweden.
    Machado, Mikael
    Karolinska Institute, Sweden.
    Hjern, Fredrik
    Karolinska Institute, Sweden.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Syk, Ingvar
    Lund University, Sweden.
    Glimelius, Bengt
    Uppsala University, Sweden.
    Martling, Anna
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial2017In: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 18, no 3, p. 336-346Article in journal (Refereed)
    Abstract [en]

    Background Radiotherapy reduces the risk of local recurrence in rectal cancer. However, the optimal radiotherapy fractionation and interval between radiotherapy and surgery is still under debate. We aimed to study recurrence in patients randomised between three different radiotherapy regimens with respect to fractionation and time to surgery. Methods In this multicentre, randomised, non-blinded, phase 3, non-inferiority trial (Stockholm III), all patients with a biopsy-proven adenocarcinoma of the rectum, without signs of non-resectability or distant metastases, without severe cardiovascular comorbidity, and planned for an abdominal resection from 18 Swedish hospitals were eligible. Participants were randomly assigned with permuted blocks, stratified by participating centre, to receive either 5 x 5 Gy radiation dose with surgery within 1 week (short-course radiotherapy) or after 4-8 weeks (short-course radiotherapy with delay) or 25 x 2 Gy radiation dose with surgery after 4-8 weeks (long-course radiotherapy with delay). After a protocol amendment, randomisation could include all three treatments or just the two short-course radiotherapy treatments, per hospital preference. The primary endpoint was time to local recurrence calculated from the date of randomisation to the date of local recurrence. Comparisons between treatment groups were deemed non-inferior if the upper limit of a double-sided 90% CI for the hazard ratio (HR) did not exceed 1.7. Patients were analysed according to intention to treat for all endpoints. This study is registered with ClinicalTrials.gov, number NCT00904813. Findings Between Oct 5, 1998, and Jan 31, 2013, 840 patients were recruited and randomised; 385 patients in the three-arm randomisation, of whom 129 patients were randomly assigned to short-course radiotherapy, 128 to short-course radiotherapy with delay, and 128 to long-course radiotherapy with delay, and 455 patients in the two-arm randomisation, of whom 228 were randomly assigned to short-course radiotherapy and 227 to short-course radiotherapy with delay. In patients with any local recurrence, median time from date of randomisation to local recurrence in the pooled short-course radiotherapy comparison was 33.4 months (range 18.2-62.2) in the short-course radiotherapy group and 19.3 months (8.5-39.5) in the short-course radiotherapy with delay group. Median time to local recurrence in the long-course radiotherapy with delay group was 33.3 months (range 17.8-114.3). Cumulative incidence of local recurrence in the whole trial was eight of 357 patients who received short-course radiotherapy, ten of 355 who received short-course radiotherapy with delay, and seven of 128 who received long-course radiotherapy (HR vs short-course radiotherapy: short-course radiotherapy with delay 1.44 [95% CI 0.41-5.11]; long-course radiotherapy with delay 2.24 [0.71-7.10]; p=0.48; both deemed non-inferior). Acute radiation-induced toxicity was recorded in one patient (amp;lt;1%) of 357 after short-course radiotherapy, 23 (7%) of 355 after short-course radiotherapy with delay, and six (5%) of 128 patients after long-course radiotherapy with delay. Frequency of postoperative complications was similar between all arms when the three-arm randomisation was analysed (65 [50%] of 129 patients in the short-course radiotherapy group; 48 [38%] of 128 patients in the short-course radiotherapy with delay group; 50 [39%] of 128 patients in the long-course radiotherapy with delay group; odds ratio [OR] vs short-course radiotherapy: short-course radiotherapy with delay 0.59 [95% CI 0.36-0.97], long-course radiotherapy with delay 0.63 [0.38-1.04], p=0.075). However, in a pooled analysis of the two short-course radiotherapy regimens, the risk of postoperative complications was significantly lower after short-course radiotherapy with delay than after short-course radiotherapy (144 [53%] of 355 vs 188 [41%] of 357; OR 0.61 [95% CI 0.45-0.83] p=0.001). Interpretation Delaying surgery after short-course radiotherapy gives similar oncological results compared with short-course radiotherapy with immediate surgery. Long-course radiotherapy with delay is similar to both short-course radiotherapy regimens, but prolongs the treatment time substantially. Although radiation-induced toxicity was seen after short-course radiotherapy with delay, postoperative complications were significantly reduced compared with short-course radiotherapy. Based on these findings, we suggest that short-course radiotherapy with delay to surgery is a useful alternative to conventional short-course radiotherapy with immediate surgery.

  • 196.
    Escobar Kvitting, John-Peder
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Andersson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Druvefors, Pelle
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    A phytobezoar in the acute abdomen2009In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 197, no 2, p. e21-e22Article in journal (Refereed)
    Abstract [en]

    A phytobezoar is a rare differential diagnosis in the acute abdomen. An 89-year-old woman presented with lower abdominal pain. A computed tomography scan and ultrasound suggested the presence of a bezoar. A phytobezoar was extracted surgically, and a resection was performed of the perforated small bowel segment. The etiology and management of phytobezoars are discussed.

  • 197.
    Escobar Kvitting, John-Peder
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Vanhanen, Ingemar
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Baranowski, Jacek
    Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Surgical management of outflow tract obstruction after transapical mitral valve implantation2018In: Journal of cardiac surgery, ISSN 0886-0440, E-ISSN 1540-8191, Vol. 33, no 9, p. 545-547Article in journal (Refereed)
    Abstract [en]

    Left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion of the anterior mitral valve leaflet (AML) is a known complication after mitral valve repair or transfemoral/transapical mitral valve implantation (TMVI). We present a patient with a previous mitral valve repair who developed LVOT obstruction after TMVI in whom the AML was surgically resected using a transaortic approach.

  • 198.
    Escobar Kvitting, John-Peder
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Olin, Christian L
    Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Clarence Crafoord: A Giant in Cardiothoracic Surgery, the First to Repair Aortic Coarctation2009In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 87, no 1, p. 342-346Article in journal (Other academic)
    Abstract [en]

    On October 19, 1944, Clarence Crafoord performed the first successful repair of aortic coarctation. The operation was done a year before Robert Gross did his first case (he is often claimed to have been the first). In fact, Gross had read Crafoords report before he performed his own first operation. Crafoords achievement was not an isolated event. In the late 1920s he had performed two successful pulmonary embolectomies, in the 1930s he introduced heparin as thrombosis prophylaxis, and in the 1940s he pioneered mechanical positive-pressure ventilation during thoracic operations and worked out a safe and precise technique for pneumonectomy. During the 1950s a string of innovative surgical procedures were done at his unit in Stockholm. These included the second successful case of cardiopulmonary bypass in the world, the first case of atrial repair of transposition of the great arteries, endarterectomy of the left coronary artery, and the first implantation of a pacemaker into a human. In this article we will pay tribute to Clarence Crafoord and describe some of the contributions that he and his collaborators made to the field of cardiothoracic surgery.

  • 199.
    Evertsson, Linda
    et al.
    Karolinska Inst, Sweden; Sodersjukhuset Hosp, Sweden.
    Carlsson, Carin
    Karolinska Inst, Sweden; Sodersjukhuset Hosp, Sweden.
    Turesson, Christina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Ezer, Melih Selcuk
    Karolinska Inst, Sweden.
    Arner, Marianne
    Karolinska Inst, Sweden; Sodersjukhuset Hosp, Sweden.
    Navarro, Cecilia Mellstrand
    Karolinska Inst, Sweden; Sodersjukhuset Hosp, Sweden.
    Incidence, demographics and rehabilitation after digital nerve injury: A population-based study of 1004 adult patients in Sweden2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 4, article id e0283907Article in journal (Refereed)
    Abstract [en]

    ObjectiveThe main objective of this study was to describe the epidemiology of surgically repaired digital nerve injuries in a Swedish population. Secondary objectives were to describe the demographics of the patient population, injury characteristics, post-operative care and rehabilitation. MethodsFrom 2012 to 2018, 1004 patients with a surgically repaired digital nerve injury resident in the Stockholm region were identified in the Swedish national quality registry for hand surgery and all medical records were thoroughly reviewed. ResultsThe incidence rate was 8.3 per 100.000 person-years and these injuries were more common in men than women. The median age at the time of injury was 37 years and a sharp cut was the most common mechanism of injury. Injuries were equally distributed over weekdays and the year, but surgery was most often performed on Mondays. There were no differences in treatment and rehabilitation regimens between sexes, except women were more likely than men to be operated within three days from injury. Timing and content of rehabilitation varied largely between individuals. One third of patients did not receive any sensory relearning and sensory assessment was performed in only 7%. ConclusionThe epidemiology shows no major changes over the last decade. However, we found a large individual variation in follow up visits, rehabilitation content and assessments indicating large differences in consumption of health care resources. Our findings expose the need to further improve and evaluate rehabilitation regimens after digital nerve injury.

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  • 200.
    Fagrell, D
    et al.
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Berggren, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Tarpila, Erkki
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Capsular contracture around saline-filled fine textured and smooth mammary implants: A prospective 7.5-year follow-up2001In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 108, no 7, p. 2108-2112p. 2108-2112Article in journal (Other academic)
    Abstract [en]

    In a previous prospective randomized clinical study comparing in the same patient textured and smooth saline-filled mammary implants (Biocell) with large pore size (300 to 600 mum), we saw no difference in capsular contracture. This study was undertaken in a similar way to compare capsular contracture around smooth and textured saline-filled prostheses with pores of small size. During a period of 7.5 years, the breast hardness was followed tip, and at the end of the study patient satisfaction was evaluated. Twenty healthy women with a mean age of 30 years were operated on for breast augmentation. Two surgeons performed all operations in a standardized way. Each patient received subglandularly a Siltex textured saline-filled prosthesis with a pore size of 30 to 70 mum in one breast, and a smooth saline-filled prosthesis in the other. The hardness of the breasts was evaluated after 0.5, 1, and 7.5 years using Baker grading and applanation tonometry. Eighteen patients completed 1-year and 7.5-year follow-up. Two breasts With smooth prostheses were contracted after 6 months (Baker III or IV). After I year, four patients with smooth prostheses and one with a textured prosthesis had capsular contracture (p = 0.34). Seven and one-half years after surgery, six patents with smooth and four with textured implants had contracture (p = 0.66). On two patients with smooth prostheses and one patient with a textured prosthesis, the capsule around the implant hardened between 6 and 12 months. Between 1 year and 7.5 years, three breasts with smooth and textured implants contracted and one with a textured implant softened. The patients reported on a Visual Analogue Scale (I to 10) the impact of the augmentation oil their (quality of life to be 9 +/- 1. Four patients preferred the breast with file smooth prosthesis, three preferred the breast with the textured prosthesis, and the others found both breasts equal. This study showed no significant difference of contracture with smooth versus fine textured implants. The majority of the patients preferred the smooth implants. The patients reported that the breast augmentation had had an extremely high impact on their quality of life.

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