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Bagheri M, Tietz K, von Kohout M, Fuchs PC, Lefering R, Schiefer JL. Is It Possible to Monitor the Safest Time to Perform Secondary Surgery on Free Flaps? A Clinical Evaluation of the Tewameter ®. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1327. [PMID: 39202608 PMCID: PMC11356067 DOI: 10.3390/medicina60081327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Postoperative monitoring, following free flap surgery, plays a crucial role in ensuring the survival of the flap. However, in microsurgery, not only the immediate postoperative monitoring period but also the choice of the right time for secondary surgeries is crucial for the free flap survival. There is no clear consensus concerning the right choice of timing for secondary surgery. Our aim was to evaluate transepidermal water loss (TEWL), with the objective evaluation tool Tewameter® in free flap surgery to monitor flap autonomization. Materials and Methods: Transepidermal water loss was assessed in 20 patients with microsurgically transplanted free anterior lateral thigh (ALTP) flaps. The transplantation of the ALTP-flap and the postoperative care were administered in accordance with the standard of care of the department. Measures were taken on the free flap and normal skin at follow-ups of 1, 3, and 6 months after initial free flap transplantation. Results: Transepidermal water loss gradually increased to the values found in normal skin, after 6 months. The differences between the two areas demonstrated the smallest variance after 6 months, specifically in the ALTP-flap region. The largest disparities were observed between month 1 and month 6, followed by month 3 and month 6, and month 1 and month 3. Conclusions: Free flap autonomization and physiology are complex processes. TEWL might be a valuable parameter to monitor flap autonomization. Our results indicate that TEWL in the free flap is nearly "normal" after six months. For a clear consensus of when to perform individual secondary surgery, further studies are needed.
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Affiliation(s)
- Mahsa Bagheri
- Clinic for Plastic and Hand Surgery, Burn Care Center, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, 51109 Cologne, Germany
| | - Katharina Tietz
- Clinic for Plastic and Hand Surgery, Burn Care Center, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, 51109 Cologne, Germany
| | - Maria von Kohout
- Clinic for Plastic and Hand Surgery, Burn Care Center, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, 51109 Cologne, Germany
| | - Paul C. Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, 51109 Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, University of Witten/Herdecke, 51109 Cologne, Germany
| | - Jennifer L. Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, 51109 Cologne, Germany
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Azouz HG, AbdelMohsen AM, Abdel Ghany HM, Mohamed RM. Evaluation of autonomic nervous system in children with spastic cerebral palsy: clinical and electophysiological study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cerebral palsy (CP) is the most prevalent severe motor disability among children. The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electrophysiologically.
Results
Age of the studied children ranged from 4 to 12 years. Quadriplegic type of spastic cerebral palsy constituted 82.5% of CP children while diplegic type constituted 17.5%. Based on Gross Motor Function Classification System (GMFCS), the majority of children were in levels 4 and 5. The prevalence of autonomic dysfunction symptoms were 80% for thermoregulatory abnormalities (cold extremities), 65% for chronic constipation, 52.5% for sleep disturbance, 47.5% for loss of appetite, 40% for sweating abnormalities, 25% for recurrent nausea and/or vomiting, 22.5% for increased sensitivity to light or dark and 15% for bloating. As regards sympathetic skin response, 19 CP children had unobtainable response in both upper and lower limbs while 5 children had unobtainable response in lower limbs only. All of them were in levels 4 and 5 of GMFCS. Postural hypotension was present in 20% of CP children. Mean Heart rate of CP children was significantly increased more than healthy children upon head tilt test.
Conclusions
Autonomic dysfunction has been objectively proven in CP children through absent sympathetic skin response, presence of orthostatic tachycardia and postural hypotension.
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Salmin F, Albamonte E, Morettini V, Gagliano N, Mercuri E, Sansone VA. Resolution of skin necrosis after nusinersen treatment in an infant with spinal muscular atrophy. Muscle Nerve 2019; 59:E42-E44. [PMID: 30811610 DOI: 10.1002/mus.26457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Francesca Salmin
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Emilio Albamonte
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Valentina Morettini
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | | | - Eugenio Mercuri
- Department of Child Neurology, University Hospital Policlinico Gemelli and the Pediatric NEMO Center in Rome, Rome, Italy
| | - Valeria Ada Sansone
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
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Winterhalter M, Münte S, Gerhard M, Danzeisen O, Jüttner T, Monaca E, Hoy L, Rahe-Meyer N, Kienbaum P. Prospective study comparing skin impedance with EEG parameters during the induction of anaesthesia with fentanyl and etomidate. Eur J Med Res 2010; 15:47-53. [PMID: 20452883 PMCID: PMC3352044 DOI: 10.1186/2047-783x-15-2-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Sympathetic stimulation leads to a change in electrical skin impedance. So far it is unclear whether this effect can be used to measure the effects of anaesthetics during general anaesthesia. The aim of this prospective study is to determine the electrical skin impedance during induction of anaesthesia for coronary artery bypass surgery with fentanyl and etomidate. Methods The electrical skin impedance was measured with the help of an electro-sympathicograph (ESG). In 47 patients scheduled for elective cardiac surgery, anaesthesia was induced with intravenous fentanyl 10 μg/kg and etomidate 0.3 mg/kg. During induction, the ESG (Electrosympathicograph), BIS (Bispectral IndeX), BP (arterial blood pressure) and HR (heart rate) values of each patient were recorded every 20 seconds. The observation period from administration of fentanyl to intubation for surgery lasted 4 min. Results The ESG recorded significant changes in the electrical skin impedance after administration of fentanyl and etomidate(p < 0.05). During induction of anaesthesia, significant changes of BIS, HR and blood pressure were observed as well (p < 0.05). Conclusions The electrical skin impedance measurement may be used to monitor the effects of anesthetics during general anaesthesia.
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Affiliation(s)
- Michael Winterhalter
- University of Düsseldorf, Department of Anaesthesiology, Moorenstr.5, 40225 Düsseldorf, Germany.
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Saari A, Tolonen U, Pääkkö E, Suominen K, Jauhiainen J, Sotaniemi KA, Myllylä VV. Sudomotor dysfunction in patients with optic neuritis. Clin Auton Res 2010; 20:199-204. [PMID: 20213266 DOI: 10.1007/s10286-009-0052-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 12/30/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Optic neuritis (ON) is a frequent initial manifestation of multiple sclerosis (MS). Autonomic failure affecting the pupillary function is known to exist in ON patients, and patients with MS are known to have more widespread autonomic dysfunction. For example, sudomotor dysfunction is well known in MS. We carried out a study investigating sudomotor abnormalities in ON patients, and later followed these patients at risk of developing MS. METHODS Firstly, sudomotor function was measured by sympathetic skin responses (SSRs) in 13 ON patients and in 22 healthy controls. Secondly, thermoregulatory sweating was measured by an evaporimeter after a heating stimulus in 13 ON patients and in 14 healthy control subjects. RESULTS The SSR latencies to electrical stimuli in the ON patients were significantly prolonged in the upper and lower extremities (p = 0.013-0.002), indicating sudomotor dysfunction. No statistically significant thermoregulatory sweating dysfunction could be found in the ON patients compared to the controls. All ON patients underwent a follow-up (mean duration 12.5 years) during which eight ON patients (62%) converted to clinically definite MS. It seemed that SSRs had no value for identifying patients who later developed MS. INTERPRETATION Our results enlarge the knowledge of autonomic disorders in ON patients, showing that sudomotor function may also be involved.
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Affiliation(s)
- Anne Saari
- Department of Neurology, Oulu University Hospital, Oulu, Finland.
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Longin E, Dimitriadis C, Shazi S, Gerstner T, Lenz T, König S. Autonomic nervous system function in infants and adolescents: impact of autonomic tests on heart rate variability. Pediatr Cardiol 2009; 30:311-24. [PMID: 19037686 DOI: 10.1007/s00246-008-9327-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 08/05/2008] [Accepted: 10/19/2008] [Indexed: 11/30/2022]
Abstract
Measurement of heart rate variability (HRV) shows information on the functional state of the autonomic nervous system (ANS). In adults there are standardized autonomic tests and well-established ranges of normal values, which is not the case in children. The aim of the present study was (1) to introduce an ANS test battery, especially for children and adolescents; (2) to establish normative HRV parameters; and (3) to determine the impact of ANS tests on HRV parameters compared with baseline measurements. We investigated 100 healthy children and adolescents between 6 and 15 years old. We subdivided the investigated group into a group of children (5-11 years old) and adolescents (12-15 years old) and measured HRV by time and frequency domain parameters during baseline, rhythmic breathing, Valsalva test, active standing, tilt-table testing, and handgrip test. The normative HRV data are presented by means, SDs, medians, and percentiles. The results described refer to baseline values for each HRV parameter separately to demonstrate the influence of age on HRV parameters. The study results present not only first normative HRV data for an autonomic test battery especially adapted to children and adolescents, but they also quantify the autonomic changes induced by test procedures compared with baseline measurements.
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Affiliation(s)
- Elke Longin
- Children's Hospital, University of Mannheim, Mannheim, Germany.
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Saari A, Tolonen U, Pääkkö E, Suominen K, Pyhtinen J, Sotaniemi KA, Jauhiainen J, Myllylä VV. Sympathetic skin responses in multiple sclerosis. Acta Neurol Scand 2008; 118:226-31. [PMID: 18355393 DOI: 10.1111/j.1600-0404.2008.01003.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study assessed the sympathetic skin responses (SSRs) and their correlation with brain lesion volumes in patients with multiple sclerosis (MS). MATERIALS AND METHODS The SSRs were measured in 27 patients with MS and 27 healthy controls. The volumes of the proton density-weighted MS lesions in the brain were measured using MRI. RESULTS The SSRs were abnormal in 52% of the patients with MS, but absent only in clinically severe MS. The total lesion volume in the whole brain correlated significantly with both the severity of MS expressed by the EDSS score (P < 0.001) and the decreased SSR amplitudes in the feet (P < 0.01). Focal lesion volumes in the temporal lobe (P < 0.01), in the pons (P < 0.01) and in the cerebellum (P < 0.01) were also separately associated with abnormal SSR reflexes. CONCLUSIONS Sudomotor regulation failure in MS is associated with certain focal MS lesions.
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Affiliation(s)
- A Saari
- Department of Neurology, Oulu University Hospital, Oulu, Finland.
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Wenderhold W, Kunkel M, Eicke BM, Reimers CD. Continuous wave Doppler ultrasound for evaluation of vasomotor tone of the radial artery. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 10:11-20. [PMID: 10502635 DOI: 10.1016/s0929-8266(99)00039-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE At present, the sympathetic skin response (SSR) is the only routinely employed technique for evaluating the autonomic function of peripheral nerves. The present study was conducted in order to compare SSR to continuous wave Doppler (CWD) of the radial artery in both healthy control subjects and patients with lower brachial plexus lesions. METHODS Both methods were performed in 50 healthy volunteers (aged 23 to 70 years; mean age and standard deviation, 39.6+/-14.3 years) and six patients presenting with severe lesions of the lower brachial plexus (aged 22 to 60 years; mean age, 37.6+/-16.0 years). RESULTS In each control subject, a SSR could be evoked with a mean latency of 1.2+/-0.2 s and a mean amplitude of 2.9+/-1.5 mV. In 45 healthy subjects, CWD revealed both a reduction of systolic, diastolic, and mean peak blood flow velocity after electrical (ES) and acoustic (AS) stimulation as well as after inspiratory cough (IC). The mean latencies to the decrease in flow velocity decrease amounted to 1.8+/-0.7, 2.0+/-0.7, and 1. 4+/-0.4 s, respectively. The resistance (Pourcelot) index increased significantly. CWD failed to show changes of blood flow velocity in five healthy subjects due to high sympathetic tone (no baseline diastolic blood flow) or instability of blood flow caused by respiration. In patients with lower brachial plexus lesions, SSR was diminished and changes in blood flow could not be observed on the affected side. CONCLUSION CWD sonography allows easy quantitative assessment of arteriolar tone in healthy subjects and patients with autonomic nerve lesions of the limbs.
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Affiliation(s)
- W Wenderhold
- Abteilung für Klinische Neurophysiologie, Georg August Universität, Robert Koch Str. 40, D-37075, Göttingen, Germany
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Eicke BM, Mink S, Küllmer K, Krummenauer F. Comparison of the sympathetic skin response and continuous wave Doppler sonography of the radial artery. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1999; 75:202-6. [PMID: 10189123 DOI: 10.1016/s0165-1838(98)00186-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The value of neurophysiological tests of the autonomic nerve system is limited. One of the clinically most commonly applied test is the skin sudomotor response, frequently referred to as 'sympathetic skin response' (SSR). However, the SSR is a more qualitative than quantitative evaluation technique. Continuous wave (cw) Doppler sonography of the radial artery may be an alternative quantitative approach. We studied 41 age matched volunteers (23 female, 18 male; 16-82 years (mean age 53 years)). The stimulus was a loud and unexpected acoustic signal, alternatively a cough. SSR evaluation included the latency of onset, the duration and the amplitude of the response. Doppler evaluation also included flow velocity and resistance index (RI) changes with adequate stimulation. SSRs were observed in 36 volunteers (88%), Doppler responses in 35 (85%). The latency between stimulus and response onset was 1.35 s with SSR and 1.52 s with ultrasound (n.s.). The mean SSR amplitude was 1.3 mV, systolic velocities decreased by 20% and diastolic velocities by 124% (flow reversal). RI increased from 0.85 to 1.25 with no correlation between SSR amplitude and flow velocity changes. SSR and cw Doppler are complementary methods. Doppler sonography offers an additional approach of autonomic nerve evaluation.
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Affiliation(s)
- B M Eicke
- Department of Neurology, University of Mainz, Germany.
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