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Rusig RP, Alves DYYO, Nascimento ADOS, dos Santos GB, Mattar R, Iamaguchi RB. RANDOMIZED EXPERIMENTAL STUDY OF TOPICAL VASODILATORS IN MICROSURGERY WITH COST ANALYSIS. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e276513. [PMID: 39086848 PMCID: PMC11288313 DOI: 10.1590/1413-785220243203e276513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/03/2023] [Indexed: 08/02/2024]
Abstract
Objective Throughout microsurgical anastomosis, many surgeons use topical vasodilators in order to reduce pathological vasospasm. It was carried out an experimental study comparing the effectiveness of topical use of Nitroglycerin, Papaverine, Magnesium sulfate over a control group in the femoral artery and vein of rats, in reducing prolonged vasospasm. Methods Randomized comparative experimental study in 15 rats, divided into four groups. The external diameter of the vases soaked in the randomized solution was measured. For statistical analysis, it was calculated the percentual increase in the external diameter of the vessels. Results A statistically significant increase in arterial dilation was observed after 10 minutes of topical application of 10% magnesium sulfate compared to the control group, with p = 0.044 . No other drug showed a vasodilator effect superior to the control group. Magnesium sulfate at 10% is still not used in microsurgery and costs 15 times less than papaverine, the standard drug for topical vasodilation in clinical cases at our service. Conclusion Magnesium sulfate had better vasodilating effects over the control group after 10 minutes of arterial microanastomosis. None of the tested drugs have presented superior vasodilating effects over each other nor the control group after venous microanastomosis. Level of evidence II, Experimental study, Randomized Trial.
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Affiliation(s)
- Renato Polese Rusig
- Universidade de São Paulo, Faculdade de Medicina, Hand Surgery and Reconstructive Microsurgery Group, Instituto de Ortopedia e Traumatologia Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil
| | - Debora Yumi Yoshimura Orlandin Alves
- Universidade de São Paulo, Faculdade de Medicina, Hand Surgery and Reconstructive Microsurgery Group, Instituto de Ortopedia e Traumatologia Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil
| | - Amanda de Oliveira Silva Nascimento
- Universidade de São Paulo, Faculdade de Medicina, Hand Surgery and Reconstructive Microsurgery Group, Instituto de Ortopedia e Traumatologia Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil
| | - Gustavo Bispo dos Santos
- Universidade de São Paulo, Faculdade de Medicina, Hand Surgery and Reconstructive Microsurgery Group, Instituto de Ortopedia e Traumatologia Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil
| | - Rames Mattar
- Universidade de São Paulo, Faculdade de Medicina, Hand Surgery and Reconstructive Microsurgery Group, Instituto de Ortopedia e Traumatologia Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil
| | - Raquel Bernardelli Iamaguchi
- Universidade de São Paulo, Faculdade de Medicina, Hand Surgery and Reconstructive Microsurgery Group, Instituto de Ortopedia e Traumatologia Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil
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Martins-Filho FVF, do Carmo Iwase F, Silva GB, Cho AB, Wei TH, de Rezende MR, Mattar R, Iamaguchi RB. Do technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury? Orthop Traumatol Surg Res 2021; 107:102827. [PMID: 33516891 DOI: 10.1016/j.otsr.2021.102827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The traumatic lesions of the brachial plexus in adults are devastating injuries causing continuous severe functional impairment for both work and daily living activities. The restoration of elbow flexion is one of the most important movements for patient recovery to previous activities. Free gracilis muscle transfer has good outcomes for cases with late presentation or as a rescue surgery to regain elbow flexion, however, bad results are present in all cohorts with insufficient recovery of muscle strength for elbow flexion. A number of hypotheses can be postulate to explain the fair results observed in some cases of free gracilis muscle transfer for elbow flexion. Most studies in the current literature compare the choice of the donor nerve used in neurotization and nerve grafts. The aim of this study is to evaluate if technical components of microvascular anastomosis could influence the functional outcome of free functional muscle transfer for elbow flexion in adult patients with traumatic brachial plexus injury. MATERIAL AND METHODS Included all adult patients with traumatic brachial plexus injury submitted to free functional gracilis muscle transfer for elbow flexion. The complications and functional results according to British Medical Research Council (BMRC) score were recorded. RESULTS We assessed 26 patients with mean age of 32.8 years. The most common donor nerve for gracilis muscle was the accessory nerve in 18 patients. Eighteen patients presented with good result (M3/M4). The mean ischemia time was higher for patients with bad results (132 minutes) comparing with patients with good results (122 minutes). Patients with only one venous anastomosis had 41% of poor functional outcome compared with 22% of cases with two venous anastomoses. No statistically significant difference in the ischemia time of the cases with good or poor functional outcome was observed (p=0.657), as for the number of venous anastomoses (p=0.418). CONCLUSION Our study observes that patients with only one venous anastomoses for drainage of free gracilis and those with longer intraoperative ischemia time had higher incidence of poor functional outcome of free gracilis muscle transfer for elbow flexion, but not statistically significant. LEVEL OF PROOF II; prospective cross-sectional study.
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Affiliation(s)
- Francisco Vilmar Felix Martins-Filho
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Fernanda do Carmo Iwase
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Gustavo Bersani Silva
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Alvaro Baik Cho
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Teng Hsiang Wei
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Marcelo Rosa de Rezende
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Rames Mattar
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Raquel Bernardelli Iamaguchi
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil.
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Pier MM, Pasick LJ, Benito DA, Saini P, Patel S, Joshi AS, Goodman JF, Thakkar P. Adverse Events Associated with Implantable Dopplers during Microvascular Surgery. J Reconstr Microsurg 2020; 37:365-371. [PMID: 32942309 DOI: 10.1055/s-0040-1716858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Implantable Dopplers (IDs) are widely used for postoperative free flap vascular monitoring. However, IDs may contribute to free flap complications or failure and better understanding of device malfunctions is needed. METHODS The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for all reports of ID adverse events from two leading manufacturers (Cook Vascular and Synovis Life Technologies) in free flap surgery from January 2010 to March 2020. Reports were reviewed and categorized. A comparison of reoperations within select categories was performed using Chi-square analysis. RESULTS Of 209 included reports, the most common device malfunctions were venous anastomotic coupler misalignment (35.4%) and coupler ring detachment (24.4%). Synovis devices were used in 100% of reports of vessel compression and Cook Vascular devices were used in 77.7% of reports of probe detachment. Of 74 patient-related adverse events, the most common were reoperation (47.3%) and vessel occlusion (28.4%). Of five reported events of flap failure, two were associated with loss of ID signal. The proportion of Doppler signal loss events leading to reoperation was significantly greater than the proportion of any other Doppler-related event leading to reoperation. Intraoperative coupler replacement was the most commonly reported intervention (n = 86), and venous anastomosis with hand-suturing occurred in 30 device malfunctions. CONCLUSION This study demonstrates a variety of ID-related malfunctions. One-third of device malfunctions were associated with patient complications, and false-positive Doppler signal loss contributed substantially to the requirement of surgical re-exploration. These are important considerations for surgical teams utilizing IDs in free tissue transfer procedures.
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Affiliation(s)
- Matthew M Pier
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Luke J Pasick
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel A Benito
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Prashant Saini
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sahil Patel
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Arjun S Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Joseph F Goodman
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Punam Thakkar
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Tarabishy SP, Inglesby D, Tapp M, Corral GD, Herrera FA. Thrombocytosis is associated with complications after microvascular surgery: An NSQIP data analysis. Microsurgery 2019; 40:288-297. [DOI: 10.1002/micr.30530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/27/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Sami P. Tarabishy
- Division of Plastic Surgery Medical University of South Carolina Charleston South Carolina
| | - Dani Inglesby
- College of Medicine Medical University of South Carolina Charleston South Carolina
| | - Marion Tapp
- College of Medicine Medical University of South Carolina Charleston South Carolina
| | - Gabriel Del Corral
- Department of Plastic Surgery Medstar Georgetown University Hospital Washington District of Columbia
| | - Fernando A. Herrera
- Division of Plastic Surgery Medical University of South Carolina Charleston South Carolina
- Department of Surgery, Ralph H Johnson Veterans Affairs Medical Center Charleston South Carolina
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Scarlat MM. About Orthopaedic awards, drains, patients safety and outcomes. INTERNATIONAL ORTHOPAEDICS 2019; 43:2001-2002. [PMID: 31396658 DOI: 10.1007/s00264-019-04388-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marius M Scarlat
- Clinique Chirurgicale St Michel, Groupe ELSAN, Avenu Orient, Toulon, France.
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Muoghalu ON, Eyichukwu GO, Iyidobi E, Anyaehie UE, Madu KA, Okwesili IC. A comparison of the use and non-use of closed suction wound drainage in open reduction and internal fixation of femoral shaft fractures. INTERNATIONAL ORTHOPAEDICS 2019; 43:2003-2008. [PMID: 31250086 DOI: 10.1007/s00264-019-04364-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to determine if the routine use of closed suction wound drainage is justified following open reduction and internal fixation (ORIF) of femoral shaft fractures. METHOD This was a prospective comparative study of two study groups: those with post-operative closed suction drainage (WCSD) and those not with closed suction drainage (NWCSD). RESULTS Fifty-six patients, twenty-eight each for the two cohorts, were recruited for this study. Five patients (17.9%) in the WCSD group and only one patient (3.6%) in NWCSD group had surgical site infection (p = 0.20). Four patients (14.3%) in the WCSD group and nine (32.1%) in NWCSD group had wound dressing reinforcements (p = 0.21). CONCLUSION There was generally no statistically significant difference in the incidence of wound infections, strike through bloodstain with wound dressing reinforcement and duration of hospital stay in patients with and without closed suction wound drainage after ORIF of femoral shaft fractures. The duration of the injury may however influence the decision to use or not use wound drain after surgery.
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Affiliation(s)
- Obiora N Muoghalu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria.
| | | | - Emmanuel Iyidobi
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
| | - Udo E Anyaehie
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
| | - Kenechi A Madu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
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Ebner JJ, Mehra T, Gander T, Schumann P, Essig H, Zweifel D, Rücker M, Slankamenac K, Lanzer M. Novel application of the Clavien-Dindo classification system and the comprehensive complications index® in microvascular free tissue transfer to the head and neck. Oral Oncol 2019; 94:21-25. [PMID: 31178208 DOI: 10.1016/j.oraloncology.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/11/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Julian Jakob Ebner
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
| | - Tarun Mehra
- Medical Office, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Thomas Gander
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Paul Schumann
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Daniel Zweifel
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Martin Rücker
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
| | - Ksenjia Slankamenac
- Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Martin Lanzer
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich (Head of Department Prof. Dr. Med. Dr. Med. Dent. Martin Rücker), Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland
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