Gasparyan Technique of Total Autologous Mitral Valve Substitute for Irreparable Cases | Chapter 3 | New Visions in Medicine and Medical Science Vol. 10

However, in patients with rheumatic valve disease mitral valve repair has an unacceptably high risk of recurrent cases or the valve even becomes fully irreparable. Even in the case of degenerative mitral valve disease, a significant proportion of valves (10%) become irreparable due to severe distortion of the valve. I have invented my method of mitral valve tailoring for its total autologous reconstruction guiding the main principle – the tailored valve has to resemble natural mitral valve anatomy as much as possible, including its primary chordal support. This is a very simple, precise and reproducible method of determination of mitral valve parameters. To make an intra-operative mitral valve tailoring simple, fast and reproducible I offered the templates of different sizes based on the inter-commissural distance of the valve and the formulas described in my method. The first successful clinical case report is described in this chapter. My method of total autologous reconstruction of the mitral valve was used to operate a 56-year-old man with severe rheumatic mitral stenosis (valve area = 0,9 cm², max PG on the valve = 31 mm Hg) with heavily calcified posterior leaflet and aortic insufficiency III degree, complicated with septic endocarditis and treated with antibiotics for 2 weeks. Preoperative echocardiography showed preserved left ventricular function (EF = 64%, LVEDD = 5,6 cm, LVEDV = 156 ml, LVESV = 56,3 ml). Trans-thoracic echocardiography follow-up 1 month after surgery revealed trivial regurgitation and a peak gradient of 6,6 mm Hg on the newly created pericardial mitral valve. Total autologous mitral valve reconstruction is a safe and effective procedure for severe, irreparable, mitral valve pathologies. However, the mid-term and long-term results need to be compared with conventional mitral valve replacement with a prosthetic valve in a randomized controlled trial.

 

Author (s) Details

 

Vahe Ch Gasparyan

Department of Cardiovascular Surgery, “Erebouni” Medical Center, Yerevan, Armenia.

 

Please see the book here:- https://doi.org/10.9734/bpi/nvmms/v10/3300

Free Fibula Osteocutaneous Flap: Advanced Techniques for Soft Tissue Defect Reconstruction | Chapter 10 | Key Flaps in Plastic Surgery

 This book chapter presents a case report and discussion on the use of the free fibula Osteocutaneous flap for the reconstruction of a posttraumatic soft tissue defect with a GIIIB fracture of the tibia and a 6 cm bone defect in the middle third of the left leg. The chapter provides a detailed case presentation, operative procedure, and an extensive discussion on the surgical technique, advantages, and limitations associated with the free fibula Osteocutaneous flap.

The case presentation describes a patient who suffered soft tissue loss and a fracture of both bones in the left leg due to a road traffic accident. Clinical examination revealed a soft tissue defect with a GIIIB fracture of the tibia and a 6 cm bone defect in the middle third of the leg, with an extensor fixator in situ. The surgical intervention involved reconstruction using a free fibula Osteocutaneous flap. The wound was debrided, the dimensions of the soft tissue and bone defects were measured, and the flap was planned and marked on the contralateral leg. The flap was raised, transferred to the defect, and reconstruction was achieved after microvascular anastomosis. The donor site was grafted with split-thickness skin grafts. The postoperative period was uneventful, and satisfactory results were observed during follow-up examinations.

The discussion section introduces the free fibula Osteocutaneous flap as a complex surgical technique used to reconstruct large or composite defects in various anatomical regions, commonly in the head and neck, jaw, and extremities. The surgical technique is described in detail, including patient evaluation and planning, preoperative imaging and vascular planning, flap harvesting, preparing the recipient site, microvascular anastomosis, and flap fixation and soft tissue reconstruction.

The advantages of the free fibula Osteocutaneous flap, such as adequate tissue volume and versatility, vascularized bone transfer, potential for dental rehabilitation, and potential for long-term stability and function, are discussed. The limitations, including surgical complexity and donor site morbidity, are also addressed.

In conclusion, this book chapter provides valuable insights into the use of the free fibula Osteocutaneous flap for the reconstruction of posttraumatic soft tissue defects with associated bone defects. Through a case report, operative details, and an extensive discussion, the chapter highlights the efficacy, considerations, and potential limitations associated with this surgical technique. This information can guide surgeons in making informed decisions and achieving successful outcomes in the reconstruction of complex defects using the free fibula Osteocutaneous flap.

Author(s) Details:

Mohd. Altaf Mir,
Department of Burns and Plastic Surgery, All India Institute of Medical Sciences (AIIMS),Bathinda-151001, India.

Jaya Jain,
All India Institute of Medical Sciences (AIIMS), Bathinda-151001, India.

Please see the link here: https://stm.bookpi.org/KFPS/article/view/11505

On Becoming Moral: Bellow’s Jewishness and Exclusion | Chapter 03 | Selected Topics in Humanities and Social Sciences Vol. 9

 This paper will compare and contrast how a philosopher writes about a poet with how a poet writes about a philosopher, or how a stranger writes about another stranger. In other words, it will be a discussion of exclusionary and inclusionary strategies in the process of rebuilding the Jewish community and legislating for its moral standards. The terms 'exclusion' and 'inclusion' are not meant to be taken literally; rather, the researcher will focus on their ontological and philosophical implications. This topic will have to be kept to a minimum. On this basis, the researcher will examine two Saul Bellow narratives: Humboldt's Gift [1] and Ravelstein [2]. The assumption is that they perfectly encapsulate Bellovian exclusionary philosophy. In both narratives, moving beyond the subjects' alienated world can take two forms: ontological exclusion and intellectual madness, or faith and pure insight, where the former seeks reconciliation through philosophical meditations on a beyond-outside the individual subject, while the latter seeks reconciliation by turning inward, to the self that can remain unsullied by social world vanity.

Author(S) Details

Ramzi Marrouchi
Department of English, Faculty of Letters, Arts and Humanities, University of Manouba, Tunisia.

View Book:- https://stm.bookpi.org/STHSS-V9/article/view/5366

Chest Wall Reconstruction after Surgical Resection: An Approach towards Various Techniques and Materials | Chapter 5 | Highlights on Medicine and Medical Science Vol. 12

 Extensive chest wall excision and rebuilding is a difficult treatment that necessitates a multidisciplinary approach involving thoracic, plastic, and oncology. Neoplastic chest wall diseases have a high surgical morbidity rate and can result in full thickness abnormalities that are difficult to repair. The objectives of a successful chest wall reconstruction are to restore rigidity to the chest wall, retain ventilatory mechanics, and protect the intrathoracic organs. To restore thoracic cage rigidity, large full thickness defects require restoration with synthetic, biologic, or composite meshes with or without titanium plate. Direct sutures, skin grafts or local advancement flaps, pedicled myocutaneous flaps, or free flaps can be used to ensure full tissue covering if skeletal stability is established. The goal of this chapter is to show the indications for chest wall reconstruction as well as the various materials and techniques that can be used to achieve the greatest chest wall stiffness and soft tissue coverage.

Author (S) Details

Stefano Sanna
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Angelo Ciarrocchi
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Alessio Campisi
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Sara Mazzarra
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Desideria Argnani
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Fabio Davoli
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Stefano Congiu
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

Franco Stella
Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni Hospital, Forli, Italy.

View Book :- https://stm.bookpi.org/HMMS-V12/article/view/2696

Fournier’s Gangrene – Management in Rural Tertiary Centre | Chapter 6 | Highlights on Medicine and Medical Science Vol. 16

 Fournier's gangrene is a potentially lethal synergistic necrotizing fascitis of the external genitalia and perineal tissues. Young men are the most commonly impacted, but women and children can also be affected. The mainstay of treatment and a crucial determinant of prognosis is the use of broad-spectrum antibiotics and surgical intervention with serial wound debridement. Rebuilding a soft tissue defect after it has been debrided is a challenging task. The purpose of this study is to assess surgical approaches for repairing soft tissue abnormalities caused by Fournier's gangrene. gangrene. Methods: All patients with necrotizing fasciitis of the external genitalia and perineum who presented to our hospital, regardless of age or gender, were included in this prospective study. Age, gender, aetiology, predisposing variables, clinical features, defect location, type of bacterial flora, reconstructive treatment, length of hospital stay, post-operative pain, patient satisfaction, and death, if any, were all looked into. The procedure was chosen based on the severity of the deformity, the availability of local tissue, and the preferences of the patient. Reconstructive treatments were performed on 31 individuals. Participants ranged in age from four to seventy-four years old (mean 38.5). The most common symptoms were pain, scrotal enlargement, and fever. The most common cause was urogenital diseases. Ten patients were treated with split-thickness skin grafts, five with secondary suturing, two with unilateral superomedial thigh flaps, four with bilateral superomedial thigh flaps, five with tensor fascia lata flaps, two with medial thigh V-Y advancement flaps, and one with perineal artery flap. Conclusion: Early presentation, early diagnosis, and intervention with debridement and appropriate antibiotics are the pillars of treatment, according to this study. Soft tissue abnormalities created by wound debridement, with the exception of one case, necessitated surgical reconstruction, reducing morbidity, hospital stay, and patients' return to normal life.

Author (S) Details

Dr. Naveen Narayan
Department of Plastic & Reconstructive Surgery, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India.

Dr. Ravi H. Shivaiah
Department of Plastic & Reconstructive Surgery, JSS hospital, Mysore, Karnataka, India.

Dr. Suhas Narayan Swamy Gowda
Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India.

View Book :- https://stm.bookpi.org/HMMS-V16/article/view/2391