OBJECTIVETo investigate the curative effect of penile elongation with four differentoperative approaches.

METHODSThrough four different operative approaches (the coronary sulcus ringincision, Y or Z shaped incision or Z shaped incision combined with coronary sulcus ring incision), thepenile skin and fascia were degloved until the penile root. Then the superficial and deep dorsal penilesuspensory ligament were cut off. After electric coagulation of the residue ends, the two-side tissue at thefront of the pubic symphysis was sutured. Then the penile skin and fascia were repositioned and the incisionat the inner and outer plate was closed.

RESULTSThe increased penile static length was (2.9 ± 0.2) cmwith abdominal wall Y incision (12 cases); (3.1 ± 0.3) cm with transabdominal modified Z incision (260 cases); (3.9 ± 0.7) cm with coronary sulcus ring incision (363 cases); (3.4 ± 0.8) cm with combined incision (39 cases). The lengthening effect was significantly different between the coronary ring incision and abdominal wall Y/Z incision (P < 0.05). The postoperative follow-up period was 6 months to 5.5 years without serious complications. Only 3 cases of subcutaneous hematoma occurred with treatment of debridement and drainage. 4 cases with ischemic necrosis at distal penile skin, were treated with debridement, dressing and physiotherapy, leaving no scar.

CONCLUSIONSPenile lengthening surgery are safe and effective through different approaches. The coronal ring incision has the best therapeutic effect.

Bandages ; Debridement ; Drainage ; Electrocoagulation ; Fasciotomy ; Follow-Up Studies ; Humans ; Ligaments ; surgery ; Male ; Necrosis ; surgery ; Organ Size ; Penis ; anatomy & histology ; pathology ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Skin ; Time Factors

OBJECTIVE: To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). MATERIALS AND METHODS: Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. RESULTS: On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. CONCLUSION: Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.
Adolescent ; Adult ; Ankle Injuries/pathology/*radiography ; Ankle Joint/*radiography ; Arthroscopy ; Chronic Disease ; Female ; Humans ; Joint Instability/pathology/radiography/*surgery ; Ligaments, Articular/pathology/radiography ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Young Adult

OBJECTIVETo observe the origins and insertions of Pitanguy ligament,in order to find the anatomically theoretical basis for the treatment of nasal deformity such as drooping nose, short columella, gingival show.

METHODS15 cadaveric heads fixed by 10% formalin were used. 12 specimens underwent nasal anatomic study. The skin was incised, along the nasal midline to expose the Pitanguy ligament. The origin of Pitanguy ligament and its relationship with surrounding tissue were studied. Then the Pitanguy ligament was taken out for HE staining. Longitudinal section along the ligament was observed. 3 specimens underwent harvesting of full-thickness nasal tissue from skin to periosteal membrane. Then the samples were used for HE staining to show histologic study of ligament at horizontal section.

RESULTSPitanguy ligament originates in the midline of lower third of the nasal superficial musculoaponeurotic system, extends down to the tip along the midline of the nasal dorsum and then turns backwards at the nasal tip, and runs between the medial crura of the lower lateral cartilages, inserts into the base of columella. Its muscle is connected with the orbicularis oris muscle and the depressor septi nasi muscle. HE staining showed the ligament consists of fibrous connective tissue, muscle tissue and other ingredients, but without cartilage.

CONCLUSIONSPitanguy ligament exists with complex histological composition, so its name is still controversial. Because it has multiple connection with the orbicularis oris muscle and the depressor septi nasi muscle, so cutting or shortened the Pitanguy ligament can treat deformity of nose and lip by adjustment of nasolabial angles and the nasal length.

Cadaver ; Cartilage ; anatomy & histology ; Facial Muscles ; anatomy & histology ; Humans ; Ligaments ; anatomy & histology ; Lip ; anatomy & histology ; Nasal Septum ; anatomy & histology ; Nose ; anatomy & histology ; Nose Deformities, Acquired ; pathology ; surgery ; Subcutaneous Tissue ; anatomy & histology

BACKGROUNDThe treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments (T-OPLL) were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL (resection or floating).

METHODSData of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups: subgroup 1 (the resection group) where the OPLL was completely resected and subgroup 2 (the floating group) where the OPLL was floated.

RESULTSA total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B. The main complications included cerebrospinal fluid (CSF) leakage and postoperative neurologic deterioration (ND). Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up.

CONCLUSIONSCircumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine. Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the "floating" group.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Longitudinal Ligaments ; pathology ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; surgery ; Retrospective Studies ; Thoracic Vertebrae ; surgery ; Treatment Outcome

BACKGROUNDSurgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion (PTTIF) may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

METHODSSixteen patients with thoracic myelopathy due to concurrent OLF and OPLL at the same level underwent PTTIF. We investigated clinical outcomes and neurological improvements. Magnetic resonance imaging (MRI) was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated.

RESULTSThe mean operating time was 275 minutes, and the mean operative bleeding amount was 1031 ml. Cerebrospinal fluid leakage occurred in three patients and healed well after repair. Neurological symptom deterioration occurred in one patient, but the patient recovered to nearly the preoperative level after methylprednisolone treatment. The follow-up period ranged from 28 to 47 months. The mean score on the Japanese Orthopedic Association scale improved from 4.3±1.2 preoperatively to 7.3±1.7 at 3 months postoperatively to 8.5±1.5 at the final follow-up (P < 0.01), with a recovery rate of (63.6±20.0)%. Postoperative images showed a significant improvement in local kyphosis (P < 0.01). Eleven patients (68.8%) showed increased signal intensity (ISI) on preoperative T2-weighted MRI. At the final follow-up, the intramedullary ISI totally recovered in five patients. Neurological improvement was worse in patients with persistent ISI than in the other patients (P < 0.05).

CONCLUSIONSPTTIF is an effective therapeutic option for combined OPLL and OLF and provides satisfactory neurological recovery and stabilized thoracic fusion through a single posterior approach. Intramedullary signal changes do not always indicate a poor prognosis; only irreversible ISI is correlated with a poor clinical result.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Ligamentum Flavum ; pathology ; surgery ; Longitudinal Ligaments ; pathology ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; pathology ; surgery ; Spinal Cord Diseases ; pathology ; surgery

OBJECTIVESTo evaluate and analyze the role of posterior ligament complex (PLC) in determining therapeutic principle for traumatic thoracic-lumbar fracture.

METHODSFrom August 2005 to May 2008, 60 patients (38 male, 22 female) who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations. According to the Magerl traumatic thoracic-lumbar fracture classification system, these cases were classified to subtype A, B and C. The average age was 34 years (21 - 65 years). Magnetic resonance imaging (MRI) scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations (such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury) and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically. Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed.

RESULTSThe sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80.8%, 83.3%, 85.3%, 80.8%, 19.2%, 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0%, 80.8%, 80.9%, 77.3%, 84.0%, 19.2%, 19.0% respectively. There were 5 cases with MRI negative results before operation but positive results during operation. Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred.

CONCLUSIONSMRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be estimated exactly before operation (especially for those unfracture dislocation cases). In order to estimate the state of PLC exactly, the related local physical examination and image technology as well as the location of the abnormal image signal in MRI film and time of injury must be analyzed synthetically.

Adult ; Aged ; Female ; Humans ; Ligaments ; pathology ; Lumbar Vertebrae ; injuries ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Fractures ; pathology ; surgery ; Thoracic Vertebrae ; injuries ; Young Adult

BACKGROUND: Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglion's nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. METHODS: This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglion's nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. RESULTS: At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. CONCLUSIONS: This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bursa, Synovial/*surgery ; Female ; Humans ; Ligaments, Articular/pathology ; Male ; Middle Aged ; Recurrence ; Synovial Cyst/pathology/*surgery ; Wrist/*surgery ; Young Adult

A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous draninage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.
Abdominal Abscess/*etiology/surgery ; Child, Preschool ; Humans ; Infection/*complications ; Ligaments/*pathology/surgery ; Male ; Umbilicus/*pathology

We present a case of perivascular epithelioid cell tumors (PEComas) in the abdominal cavity at the falciform ligament. A 30-yr-old Korean man visited to hospital for the evaluation of a growing, palpable abdominal mass. He had felt the mass growing over 6 months. There was no family or personal history of tuberous sclerosis. The resected specimen showed a mass of 8.0x7.0x5.5 cm in size. Histological examination showed sheets of spindle-to-epithelioid cells with clear-to-eosinophilic cytoplasm. Immunohistochemically, tumor cells were positive for HMB-4 (gp100) and smooth muscle actin. They were also positive for the S-100, which is a marker of neurogenic and melanocytic tumors. Patient was treated with radical resection of tumor without any adjuvant therapy. He is well and on follow-up visits without tumor recurrence.
Abdominal Neoplasms/*diagnosis/pathology/surgery ; Actins/metabolism ; Adult ; Antigens, Neoplasm/metabolism ; Humans ; *Ligaments/pathology ; Male ; Neoplasm Proteins/metabolism ; Perivascular Epithelioid Cell Neoplasms/*diagnosis/pathology/surgery ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

OBJECTIVETo study the method and effect of endoscopic two-portal one-way releasing procedure for cut of transverse carpal ligament and decompression of median nerve.

METHODSEleven female patients (13 sides) with primary carpal tunnel synrome underwent endoscopic two-portal one-way releasing procedure, there were 3 left hands, 6 right, and 2 both. All the subjects had hypesthesia in the radial three and half finger's tip with a positive, Tinel sign of median nerve at wrist; 11 cases had thenar myatrophy in which 4 had opposition dysfunction. Under local anaesthesia, the proximal incision was located at the point of the proximal carpal transverse striation level between palmaris longus and flexor carpi radialis. The outlet was chosed the junction of the parallel line of the ulnar side of thumb and proximal extending line of middle ring fingers' long axis while the thumb was in abduction position. The length of each incision was only one centimeter. The hook knife was inserted to the proximate of the transverse carpal ligament, then, the transverse carpal ligament was completely released form the proximal to the distal end by hook knife under the endoscope monitor.

RESULTSThe results showed that both pinch and grip function was satisfied and no complications occurred at 4 to 20 months followed-up. S3+ M3 or more has been reached in 3 months after operation.

CONCLUSIONThe endoscopic two-portal one-way releasing procedure is an easy and effective method for the treatment of carpal tunnel syndrome.

Adult ; Aged ; Carpal Tunnel Syndrome ; pathology ; physiopathology ; surgery ; Decompression, Surgical ; Endoscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Ligaments ; surgery ; Median Nerve ; surgery ; Middle Aged ; Recovery of Function