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PubMed1989

Patellar complications in total knee arthroplasty. A literature review.

Increased implant longevity, improved range of motion, and the use of total knee arthroplasty in younger and more active patients have placed greater demands on the patella component. Commonly observed complications of the patellofemoral joint are crepitation, subluxation, excessive wear, loosening, and persistent patient discomfort. These complications have been attributed to inadequate prosthetic design, fixation techniques, anatomic abnormalities, and surgical error. This paper reviews the most prevalent complications and discusses their causes and prevention.

Biomechanical Phenomena↗

PubMed1989

[Local late sequelae following breast saving therapy of breast cancer: problem cases and possibilities for their correction].

The variety of deformities seen after local tumorectomy and postoperative radiotherapy in small breast cancers is shown. Most of the unfavorable results are due to surgical errors or improper radiotherapy, and could therefore be avoided. Late asymmetry due to soft tissue defect of fibrosis of the irradiated breast can be corrected by uni- or bilateral asymmetric reduction mammoplasty. Musculocutaneous flaps as the latissimus dorsi or the rectus abdominis can not only cover safely big defects after removal of a radionecrosis but also lead to a satisfactory cosmetic result.

Breast Neoplasms↗

PubMed1985

[Surgical procedure in the treatment of post-traumatic pleural empyema].

Questions of pathogenesis and tactics of treatment of 62 patients with empyema of the pleura after a closed trauma and penetrating wounds of the chest are discussed. The development of empyema was dependent on the character and degree of the injury as well as on surgical errors in diagnosis and treatment of the trauma. Coagulated hemothorax was the most frequent cause of empyema. Operation was the main method of treatment, the operation of choice being pleurectomy and decortication of the lung.

Adolescent↗

PubMed1985

Pylorectomy and gastroduodenostomy in the dog: technique and clinical results in 28 cases.

Pylorectomy and end-to-end gastroduodenostomy are surgical procedures that allow excision of abnormal pyloric tissue and provide improved gastric outflow. These techniques were used for the treatment of benign, malignant, and ulcerative conditions that were judged to be not adequately treatable with pyloromyotomies or pyloroplasties. End-to-end gastroduodenostomy was not much more difficult than a standard intestinal anastomosis; however, a thorough knowledge of the pyloric area anatomy was required to avoid serious surgical errors. In addition, gentle tissue manipulation and precise suture placement reduced the chance of iatrogenic pancreatitis, biliary obstruction, tissue ischemia, and/or suture line leakage. The results of surgery depended on the underlying disease process. Dogs with benign lesions such as chronic hypertrophic pyloric gastropathy responded favorably to treatment. Dogs with malignant disease and perforated ulcers had low long-term survival rate. Pyloric adenocarcinoma was not adequately treated with this method alone.

Animals↗

PubMed1978

Resection and reconstruction for primary neoplasms involving the innominate bone.

Using described criteria for the selection of patients for excision or resection of tumors involving various portions of the innominate bone, as opposed to hemipelvectomy, fifty-seven out of the more than 200 patients evaluated were judged to be candidates for a curative procedure. Of these, twenty-five were selected for hemipelvectomy and thirty-two, for non-amputative procedures. Depending on the location and extent of the lesion as determined by complete preoperative work-ups, three types of procedures were performed singly or in combination:(1) wide excision or radical resection of the iliac wing; (2) periacetabular wide excision or radical resection; or (3) wide excision or radical resection of the pubis. Reconstruction was accomplished when the hip joint was excised by fusion or the creation of a pseudarthrosis either medially in relation to the pubis or laterally in relation to the ilium or wing of the sacrum. The results after follow-ups of one to seventeen years were assessed in terms of the immediate goals of surgery, control of the disease, and function. The findings were as follows: With the preoperative assessment and operative techniques described, an oncologically adequate procedure was performed in two-thirds of the cases. In the remaining cases, the adequacy of the procedure was compromised by poorly planned biopsies, occult microextensions, and surgical errors. The recurrence rate was high after the inadequate procedure (100 per cent) and low (4 per cent) after the adequately accomplished procedures. Function was nearly normal when the hip joint was preserved. If the hip joint was removed and fusion was obtained, the results were good, but fusion was obtained in only 50 percent of the cases in which it was attempted. If the hip joint was removed and pseudarthrosis resulted, the results ranged from good to poor. Sciatic-nerve involvement necessitating resection of the nerve was not a contraindication to a non-amputative procedure.

Acetabulum↗

PubMed1981

Reoperations for hyperparathyroidism.

During a 20 year period, 27 patients have undergone reoperations for primary hyperparathyroidism. Hypercalcemia has been successfully controlled in 21 of the 27 patients after a total of 64 operations. Reasons for failure at initial exploration included surgical error in 12, multiple gland disease in five, unusual parathyroid gland location in five, carcinoma of the parathyroid gland in two and unknown in three. A variety of techniques were used to localize missing parathyroid glands prior to reoperation. Selective venous sampling was the most helpful but gave correct localizing information in only nine of 18 patients. Postoperatively, hypoparathyroidism was temporary in two patients and permanent in four. Recurrent laryngeal nerve injury was temporary in one patient, permanent and unilateral in two and bilateral in one patient. Reoperations for hyperparathyroidism are associated with increased morbidity and decreased success. Most importantly, failure at the initial operation is preventable in most patients.

Adolescent↗

PubMed1994

[Early results of surgical treatment for congenital hip dislocation in children using Degi's method in children under 18 months of age].

Early results of surgical treatment of congential hip dislocation by the Dega method in 18 children (20 hips) aged from 6 to 17 months are presented. Following the excision of the soft tissue obstructions and Dega transiliac osteotomy stable reduction of the hip has been achieved in all cases. Proximal femoral osteotomy has been performed in 6 cases only. Clinical results were markedly superior over radiological ones. Fair radiological outcomes resulted from surgical errors or avascular necrosis of the femoral head due to the previous conservative treatment. Avascular necrosis after operative treatment has not been noted.

Hip Dislocation, Congenital↗

PubMed1995

Proximal third tibial shaft fractures. Should they be nailed?

Thirty-two extraarticular fractures of the proximal third of the tibia were treated with locked intramedullary nails. There were 10 closed and 22 open injuries. Treatment consisted of a reamed nail in each of the 5 closed fractures, and an unreamed nail in the remaining 27 fractures. Thirty of the 32 fractures eventually healed; however, 9 (28%) underwent exchange nailing and 4 (13%) required bone grafting. At final followup, 27 of 32 fractures (84%) had angulation of 5 degrees or greater in the frontal or sagittal plane. Nineteen of the 32 fractures (59%) had 1 cm or more of displacement at the fracture site. In 8 fractures (25%), there was loss of fixation, most commonly associated with placement of a single proximal locking screw. Fractures of the proximal third of the tibial shaft do not appear to respond as favorably to intramedullary nailing as do fractures in the distal 2/3 of the tibia. Valgus, apex anterior angulation, and residual displacement at the fracture site are common after nailing. Surgical errors of a medialized nail entry point and a posteriorly and laterally directed nail insertion angle contributed to malalignment. Based on their findings, the authors have limited the use of intramedullary nailing for proximal third tibial shaft fracture and consider alternate forms of fixation (plate or external fixation).

Adolescent↗

PubMed1994

[Stomach injury].

The results of treatment of 221 patients with injury to a stomach (IS), whose age range was from 3.5 to 71 years, have been analysed. Closed IS was noted in 9 (4.1%), open--in 212 (95,9%), isolated--38.5%. The main method of operative treatment (in 92.8% of sufferers) was the organ closure. Surgical errors were made in 9.5% of the patients. The postoperative complications occurred in 75 (33.9%) sufferers. Total lethality was 11.8%. A good long-term result of treatment was noted in 48.0%, a satisfactory one--in 45.2%, an unsatisfactory one--6.8% patients.

Adolescent↗

PubMed1994

Knee instability after total knee arthroplasty.

From 1986 to the present, 126 total knee revisions were performed by the authors. Twenty-five cases (20%) were revised for instability of the tibiofemoral articulation. Patellofemoral instability and those patients treated conservatively were excluded from this subset of patients. All patients were clinically evaluated using the Hospital for Special Surgery knee rating system and radiographically rated using The Knee Society scoring system. The average follow-up period was 28 months. Preoperative synovial fluid analysis showed a predominance of red blood cells (average, 64,000). Reasons for instability were ligamentous imbalance and incompetence, malalignment and late ligamentous incompetence, a deficient extensor mechanism, inadequate prosthetic design, and surgical error. All patients currently have stable knees with an overall improvement in clinical and radiographic scores. When evaluating a patient with a painful knee after total knee arthroplasty, this diagnosis should be considered. Careful physical examination, dynamic radiographs, and synovial fluid analysis should help to make a proper diagnosis. Treatment should aim to correct the cause of instability. The prosthesis chosen should compensate for the specific ligamentous deficiency present.

Follow-Up Studies↗

PubMedDate not supplied

An unusual cause for respiratory difficulty after thyroidectomy.

Problems with breathing immediately after extubation following thyroidectomy are rare, but can usually be attributed to a surgical error such as damage to one or both recurrent laryngeal nerves. Tracheomalacia may also cause respiratory distress following extubation. We present an unusual cause of failure to resume spontaneous respiration after thyroidectomy.

Aged↗

PubMed1995

[An unusual complication of cervicofacial lift: paralysis of the external branch of the accessory spinal nerve].

Paralysis of the lateral branch of the accessory nerve is an extremely rare lesion during cervico-facial facelift. Based on 3 detailed and published personal cases observed over a period of 15 years, the authors review the literature, revealing a total of 9 cases over a period of 30 years, but other cases have probably not been published. Their review reveals the following points. This is an exceptional lesion. However, the nerve can be damaged as it emerges from the posterior border of the sternocleidomastoid muscle during slightly deep dissection and the electrical scalpel must be used cautiously. Even, partial paralysis of the trapezius muscle induces pain and considerable functional impairment with partial permanent disability. The natural history of this paralysis is very long and may be followed by regression after several years. Although there is an obvious cause-and-effect relationship between the operation and accessory nerve paralysis, it is always difficult to attribute this lesion to a possible surgical error, as the exact mechanism of the nerve lesion remain hypothetical and once again raises the problem of therapeutic risk.

Accessory Nerve Injuries↗

PubMed1997

Endoscopic removal of nasogastric tube sutured unintentionally to gastrojejunostomy.

A nasogastric tube mistakenly sutured to the anastomotic site is a rare surgical error during gastrointestinal operation. When it does happen, proper management will prevent subsequent complications. If resistance is experienced when pulling the nasogastric tube after gastrointestinal surgery, it should never be pulled more forcefully. The endoscope should be introduced to document the etiology and to provide treatment after 2 weeks postoperation based on the wound healing process and strength of suture materials.

Endoscopy↗

PubMed2005

Analysis of errors enacted by surgical trainees during skills training courses.

BACKGROUND: Despite the emphasis on medical error as a major cause of hospital morbidity and mortality, there has been little published work on errors committed by trainees. This issue is particularly relevant to the training of surgeons and was addressed by our study. METHODS: Sixty simulated laparoscopic cholecystectomies performed on restructured pig tissue models by 60 surgical trainees provided the study material. The unedited videotapes were analyzed by observational HRA of the component steps of the procedures. Ten generic forms of observable error types were used to categorize patterns of failure. Error probabilities with specific instruments were also calculated. RESULTS: A total of 1067 errors were identified by observational HRA: 331 consequential and 736 without consequence (ie, total error rate of 18 [SD +/- 10]) per procedure. The study documented a wide variation in the number of errors between the 60 trainee surgeons. The important underlying factors for the trainee errors were (1) omission of important steps, (2) execution of steps in the wrong sequence, and (3) use of excessive force. These 3 errors accounted for 92% of consequential errors. CONCLUSIONS: This study has shown that trainees vary considerably in their propensity to commit errors. This variability indicates that the surgical training in component skills for laparoscopic surgery should be flexible and individualized. Three mechanisms account for the majority of errors and indicate that skills training in surgery has to be structured, menu driven, and tailored to individual needs.

Animals↗

PubMed1999

LASIK for the correction of residual refractive errors from previous surgical procedures.

BACKGROUND AND OBJECTIVE: To evaluate laser assisted in situ keratomileusis (LASIK) efficacy in correcting residual refractive errors after corneal or intraocular surgery (penetrating keratoplasty, radial keratotomy, photorefractive keratectomy, phacoemulsification with intraocular lens (IOL) implantation, penetrating ocular trauma and phakic IOL implantation). MATERIAL AND METHODS: We performed LASIK in 87 eyes of 62 patients previously operated by means of other surgical techniques to completely correct the residual refractive error. We report the mean refractive error (in terms of spherical equivalent refraction), uncorrected visual acuity (UCVA) and spectacle corrected visual acuity (SCVA) before and after the surgical procedure. We also analyze safety and stability, in these results with a minimum of 12 months follow-up. RESULTS: Mean preoperative spherical equivalent was -5.25 +/- 2.1 diopters (D). Postoperatively, mean spherical equivalent was -0.70 +/- 0.65 D, 76% of eyes were between plano and -1.00 D and 99% were between plano and -2.25 D. At 12 months follow-up the change in the refractive result was equal or less than 0.5 D in 94% of eyes. Preoperatively SCVA was 1.0 or better in 24.13% of cases, and 0.5 or better in 89.65%. Postoperative SCVA was 1.0 or better in 26.43% and 0.5 or better in 95%. Preoperative UCVA was 0.1 in 2 eyes, 0.05 in 4 eyes and count fingers in the rest of the cases. Postoperative UCVA was 1.0 or better in 1.1% and 0.5 or better in 70.1%. We had an extremely low complication rate in this particular group of patients. CONCLUSIONS: LASIK can be successfully used to correct residual refractive errors after other surgical procedures.

Adult↗

PubMed2006

ACOG Committee Opinion #328: patient safety in the surgical environment.

Ensuring patient safety in the operating room begins before the patient enters the operative suite and includes attention to all applicable types of preventable medical errors (including, for example, medication errors), but surgical errors are unique to this environment. Steps to prevent wrong-site, wrong-person, or wrong-procedure errors have been recommended. Prevention of surgical errors requires the attention of all personnel involved in the patient's care.

Female↗

PubMed2003

Where to draw the line: the error in marking surgical excision margins defined.

We studied the accuracy of marking surgical margins for excision surrounding skin lesions, to assess if the percentage error would differ for varying increments in margin measurements. In designing an experiment to test this hypothesis, surgeons of differing experience (n=19) marked excision margins of 2, 5 and 10 mm around a standard circular lesion drawn on paper. Use of surgical markers, rulers and loupe magnification were all permitted, with five attempts for each margin. The percentage error found was 35, 14 and 4% for the 2, 5 and 10 mm margins, respectively (regardless of the grade of surgeon). Repetition of the experiment on volunteer skin demonstrated a percentage error of 45, 16 and 8% for 2, 5 and 10 mm margins (significantly greater than the corresponding errors on paper, p<0.001 in all cases). These findings indicate that for these surgically marked margins, the term "accurate excision margins" may be inaccurate to a significant degree. This study has defined the errors inherent in the marking of surgical margins, and these should be taken into account when assessing studies that report margins around tumours. Specifically, comparisons between surgical and histological margins would aid assessment of reports detailing surgical margins dawn around skin tumours.

Clinical Competence↗

PubMed2005

Factors predictive of intravenous fluid administration errors in Australian surgical care wards.

BACKGROUND: Intravenous (IV) fluid administration is an integral component of clinical care. Errors in administration can cause detrimental patient outcomes and increase healthcare costs, although little is known about medication administration errors associated with continuous IV infusions. OBJECTIVES: (1) To ascertain the prevalence of medication administration errors for continuous IV infusions and identify the variables that caused them. (2) To quantify the probability of errors by fitting a logistic regression model to the data. METHODS: A prospective study was conducted on three surgical wards at a teaching hospital in Australia. All study participants received continuous infusions of IV fluids. Parenteral nutrition and non-electrolyte containing intermittent drug infusions (such as antibiotics) were excluded. Medication administration errors and contributing variables were documented using a direct observational approach. RESULTS: Six hundred and eighty seven observations were made, with 124 (18.0%) having at least one medication administration error. The most common error observed was wrong administration rate. The median deviation from the prescribed rate was -47 ml/h (interquartile range -75 to +33.8 ml/h). Errors were more likely to occur if an IV infusion control device was not used and as the duration of the infusion increased. CONCLUSIONS: Administration errors involving continuous IV infusions occur frequently. They could be reduced by more common use of IV infusion control devices and regular checking of administration rates.

Fluid Therapy↗