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Pediatric pedicles

Prasad Krishnan, Krishnamurthy Sridhar
Traditional teaching describes two types of bone flaps in craniotomies - 'free bone flap' and osteoplastic craniotomies. While in the former, the entire bone flap devoid of soft tissue attachments is removed, in the latter the bone flap that is turned is hinged on a pedicle of temporalis muscle with the aim of retaining its vascular supply. We describe a variant of the latter in 13 pediatric patients in whom the lower margin of the craniotomy was above the attachment of the temporalis muscle and where the bone flap was lifted with all the layers of the scalp including the skin and galea, highlighting the thought process behind its performance and the advantages of the same...
October 26, 2016: British Journal of Neurosurgery
Yair Shachar, Allan Billig, Katya Chapchay, Jhonatan Elia, Neta Adler, Alexander Margulis
BACKGROUND: Large congenital melanocytic nevi entail significant medical and cosmetic ramifications for patients and families. Reconstruction is a challenging endeavor, especially when the lesion is present on the limbs. The literature describes various methods by which a plastic surgeon can address reconstruction; yet, to date, there has been no series describing a method that provides consistent results with low complication rates. In this study, we describe our surgical technique for reconstruction of the upper extremity after excision of large circumferential CNM with a pre-expanded bi-pedicled flap, namely the "sleeve" flap...
October 5, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Luis C Morales, Fernando Alvarado, José A Corredor, Andrés Rodríguez
BACKGROUND CONTEXT: Many etiologies can lead to atlantoaxial subluxaion. In Grisel's syndrome, this subluxation occurs spontaneously after inflammatory processes of the head and neck. Diagnosis is typically based on clinical history and a strong suspicion of this syndrome. Non-surgical treatment most often resolves the symptoms, however in some cases surgical treatment is necessary to repair the subluxation. Various surgical techniques and instrumentation systems have been used to treat atlantoaxial subluxation, although there is no consensus regarding the best treatment method for the pediatric population...
September 23, 2016: Spine Journal: Official Journal of the North American Spine Society
Carlos Olvera-Caballero, Abel Ortiz-Dominguez
A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi...
August 2016: Plastic and Reconstructive Surgery. Global Open
Shari Cui, Gennadiy A Busel, Aki S Puryear
BACKGROUND: Pediatric spine trauma often results from high-energy mechanisms. Despite differences in healing potential, comorbidities, and length of remaining life, treatment is frequently based on adult criteria; ligamentous injuries are fused and bony injuries are treated accordingly. In this study, we present short-term results of a select group of adolescent patients treated using percutaneous pedicle screw instrumentation without fusion. METHODS: An IRB-approved retrospective review was performed at a level 1 pediatric trauma center for thoracolumbar spine fractures treated by percutaneous pedicle screw instrumentation...
October 2016: Journal of Pediatric Orthopedics
Alvin W Su, Amy L McIntosh, Beth A Schueler, Todd A Milbrandt, Jennifer A Winkler, Anthony A Stans, A Noelle Larson
BACKGROUND: Intraoperative C-arm fluoroscopy and low-dose O-arm are both reasonable means to assist in screw placement for idiopathic scoliosis surgery. Both using pediatric low-dose O-arm settings and minimizing the number of radiographs during C-arm fluoroscopy guidance decrease patient radiation exposure and its deleterious biological effect that may be associated with cancer risk. We hypothesized that the radiation dose for C-arm-guided fluoroscopy is no less than low-dose O-arm scanning for placement of pedicle screws...
August 1, 2015: Journal of Pediatric Orthopedics
Vishal J Patel, Sohum K Desai, Ken Maynard, Randall Zain Allison, Thomas Frank, Daniel Branch, Aaron Mohanty
INTRODUCTION: Idiopathic scoliosis is the lateral curvature of the spinal column greater than 10° with no established etiology. In skeletally immature pediatric patients, risk of progression is associated with the severity of curvature. It has been estimated that this risk is nearly 90% for patients with curvatures exceeding 50°, and this is typically the severity at which surgical management is indicated. Current surgical techniques rely heavily on posterior instrumentation with pedicle screw systems...
August 2016: Neurosurgery
David W Polly, Kent Rice, Arvydas Tamkus
INTRODUCTION: There is variability in intraoperative neuromonitoring (IONM), anesthetic and surgical techniques for the treatment of pediatric spinal deformity. This study evaluates a series of patients treated at multiple centers utilizing transcranial motor and somatosensory evoked potentials (TcMEP and SSEP) and electromyography (EMG). The frequency of alerts and the intraoperative follow-up is reported. METHODS: Standard patient demographics and IONM data were collected from a two-month cohort of pediatric spine deformity cases...
March 2016: Neurodiagnostic Journal
Seth H Richman, Andrew J Razzano, Melanie A Morscher, Patrick M Riley
STUDY DESIGN: Case report. OBJECTIVE: To report a case of progressive pain and paraparesis secondary to metallosis four years after a pediatric posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: Metallosis as a late complication of pediatric spinal surgery is rarely reported. Myelographic computed tomography (CT) can be helpful in establishing the diagnosis. The use of serum chromium levels as a means of definitive diagnosis has been suggested, but has only been reported retrospectively...
May 11, 2016: Spine
Jeremy J Macke, Raymund Woo, Laura Varich
This is a retrospective review of pedicle screw placement in adolescent idiopathic scoliosis (AIS) patients under 18 years of age who underwent robot-assisted corrective surgery. Our primary objective was to characterize the accuracy of pedicle screw placement with evaluation by computed tomography (CT) after robot-assisted surgery in AIS patients. Screw malposition is the most frequent complication of pedicle screw placement and is more frequent in AIS. Given the potential for serious complications, the need for improved accuracy of screw placement has spurred multiple innovations including robot-assisted guidance devices...
June 2016: Journal of Robotic Surgery
Xiao-Qing He, Yue-Liang Zhu, Jia-Zhang Duan, Yong-Qing Xu, Tao Jin, Jun Yang, Liang-Bin Mei, Yi Wang
Severe motorcycle spoke injuries of the heel lead to Achilles tendon defects, calcaneal tubercle exposure or loss, and overlying soft tissue defects, which are challenging to treat. Given the special physiological and developmental characteristics of children, severe spoke injuries of the heel in children are especially troublesome.We report details of 31 cases of severe motorcycle spoke injuries of the heel in children. The reconstruction timing depended on the time since injury, systematic conditions, and concurrent injuries...
April 7, 2016: Annals of Plastic Surgery
Jean-Marc Mac-Thiong, Jahangir Asghar, Stefan Parent, Harry L Shufflebarger, Amer Samdani, Hubert Labelle
Anterior release and fusion is sometimes required in pediatric patients with thoracic scoliosis. Typically, a formal anterior approach is performed through open thoracotomy or video-assisted thoracoscopic surgery. The authors recently developed a technique for anterior release and fusion in thoracic scoliosis referred to as "posterior convex release and interbody fusion" (PCRIF). This technique is performed via the posterior-only approach typically used for posterior instrumentation and fusion and thus avoids a formal anterior approach...
September 2016: Journal of Neurosurgery. Spine
Baoguo Chen, Huifeng Song, Quanwen Gao, Minghuo Xu
BACKGROUND: Pediatric scar contractures in rapidly-growing regions require timely correction. Compared to flaps, skin grafts are characterized by scarring and retraction. More complex reconstructions are especially challenging in pediatric cases. Pedicled fasciocutaneous flaps are simple, durable, and able grow with the patient. METHODS: A series of 22 pediatric burn scar cases, with an average age of 6years, underwent treatment with pedicled fasciocutaneous flaps...
July 2016: Journal of Pediatric Surgery
Jonathan O Swanson, Adam M Alessio, Klane K White, Walter F Krengel, Seth D Friedman, Neil C Vining, Kit M Song
STUDY DESIGN: Retrospective dose-simulation comparison. OBJECTIVE: To determine if sufficient detail for preoperative analysis of bony anatomy can be acquired at substantially lower doses than those typically used. SUMMARY OF BACKGROUND DATA: Computed tomography (CT) is a preoperative planning tool for spinal surgery. The pediatric population is at risk to express the harmful effects of ionizing radiation. Preoperative CT scans are presently performed at standard pediatric radiation doses not tailored for surgical planning...
October 15, 2015: Spine
Pankaj Kumar Singh, P Sarat Chandra, Gaurang Vaghani, Dattaraj Paramanand Savarkar, Kanwaljeet Garg, Rajender Kumar, Shashant Sharad Kale, Bhawani Shankar Sharma
PURPOSE: Pediatric vertebral hemangiomas (VH) are exceedingly rare benign and highly vascular tumours of the spine. There are no guidelines available for management of these patients in literature. Purpose of this study is to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in pediatric symptomatic VH with single-level involvement. METHODS: Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-/long-segment instrumented fusion using pedicle screws and rod...
February 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Maria Virginia Amesty, Gloria Chocarro, Alejandra Vilanova Sánchez, Vanesa Nuñez Cerezo, C A de la Torre, Jose Luis Encinas, Manuel Gamez Arance, Francisco Hernández, Manuel Lopez Santamaria
INTRODUCTION: Central hepatectomy or mesohepatectomy (MH) is a complex surgical technique rarely used in children. It is indicated in central tumors to preserve functioning liver mass avoiding an extended right hepatectomy. The purpose of this article is to analyze our experience with this technique. METHODS: We reviewed five patients who underwent MH in the period from 2008 to 2014. Diagnoses were hepatoblastoma PRETEXT III (two cases), hepatic embryonal sarcoma (one case), focal nodular hyperplasia (one case), and vascular tumor with rapid growth in a newborn causing an acute liver failure, compartment syndrome, and multiple organ failure (one case)...
February 2016: European Journal of Pediatric Surgery
Paula Diaz-Gallardo, Jorge Knörr, I Vega-Encina, Pablo S Corona, Sergi Barrera-Ochoa, Alfonso Rodriguez-Baeza, Vasco V Mascarenhas, Francisco Soldado
Several types of vascularized periosteal flaps have recently been described for the treatment or prevention of complex non-union in pediatric patients. Among them, a vascularized tibial periosteal graft (VTPG), supplied by the anterior tibial vessels (ATV), has been used successfully as a pedicled flap in a few patients. The purpose of the study is to describe the periosteal branches of the ATV, as well as the cutaneous and muscular branches by means of an anatomical study. In addition, to report on the use of VTPG as a free flap with a monitoring skin island in a clinical case...
December 1, 2015: Microsurgery
Merisa Piper, Chetan Irwin, Hani Sbitany
BACKGROUND: In recent years, dramatic advances in the multidisciplinary treatment of pediatric sarcoma have resulted in significant improvement in the long-term survival of the patient. Thus, following tumor resection, significant effort has gone into limb salvage and improving functional outcomes. Plastic surgeons, in conjunction with orthopedic surgeons, are using techniques in microvascular free-tissue transfer and rotational flap surgery to preserve limb length. This study presents a review of the current reconstructive strategies and the oncologic, surgical, and functional outcomes in this population...
January 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Ben A Strickland, Christina Sayama, Valentina Briceño, Sandi K Lam, Thomas G Luerssen, Andrew Jea
OBJECT In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients. METHODS The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands...
October 30, 2015: Journal of Neurosurgery. Pediatrics
Dmitri van Popta, John Stephenson, Rajat Verma
BACKGROUND CONTEXT: Corrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature. PURPOSE: This study aimed to identify predictors of gain in SH following corrective surgery for AIS. We present a unique model to predict postoperative height prior to intervention, which could contribute to the preoperative counseling and consenting process...
February 2016: Spine Journal: Official Journal of the North American Spine Society
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