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Endo Y, Nwawka OK, Sneag DB. Iatrogenic "overshoot" nerve injuries: imaging features. Skeletal Radiol 2024; 53:1173-1181. [PMID: 38165469 DOI: 10.1007/s00256-023-04550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Describe features of iatrogenic "overshoot" nerve injuries on ultrasound and MRI, which occur when an instrument passes through the bone and injures the nerve after it penetrates the opposite cortex. MATERIALS AND METHODS After a keyword search of the radiology database at a tertiary care orthopedic hospital from January 2016 to December 2022, those fulfilling the inclusion criteria of (1) instrumentation through the bone during surgery, (2) acute neuropathy immediately after surgery, (3) nerve injury confirmed on electrodiagnostics, and (4) imaging consistent with overshoot nerve injury were included. Imaging studies were retrospectively evaluated to determine primary and secondary signs of an overshoot nerve injury. RESULTS Six patients (3 females, mean age 26.7 (range 10-49) years) had nerve injury fitting the mechanism of injury: 3 injuries to the radial nerve during fixation of distal humerus fractures, 1 tibial nerve and 1 superficial peroneal nerve injury during fixation of tibial fractures, and 1 posterior interosseous nerve injury during biceps tendon repair. Ultrasounds were performed in all while 4 also had MRI. Secondary signs included (1) cortical defect adjacent to injured nerve (n=2); (2) scar extending from bone to injured nerve (n=2); (3) screw tip pointing to injured nerve (n=1, 4) tract in bone on MRI from previous instrumentation pointing to injured nerve (n=2). CONCLUSION In addition to primary signs such as laceration or neuroma, secondary signs of "overshoot" nerve injury include cortical defect, scar extending to nerve, screw tip pointing to nerve, and linear tract in the bone on MRI.
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Affiliation(s)
- Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Ogonna K Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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2
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Aytekin K, Çakır İM, Taşdemir MN, Balta O. Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography. Arch Orthop Trauma Surg 2024; 144:2119-2125. [PMID: 38492060 PMCID: PMC11093777 DOI: 10.1007/s00402-024-05258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. MATERIALS AND METHODS The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. RESULTS The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. CONCLUSION Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.
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Affiliation(s)
- Kürşad Aytekin
- School of Medicine, Department of Orthopedics and Traumatology and Department of Anatomy, University of Giresun, Giresun, Turkey.
| | - İsmet Miraç Çakır
- School of Medicine, Department of Radiology, University of Giresun, Giresun, Turkey
| | - Merve Nur Taşdemir
- School of Medicine, Department of Radiology, University of Giresun, Giresun, Turkey
| | - Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Hospital, Kaleardı District Muhittin Fisunoglu Street, 60100, Tokat, Turkey
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3
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Dayal D, Zalikha AK, El-Othmani MM. Evaluating the optimal management strategy for intraoperative iatrogenic injury to the medial collateral ligament during primary total knee arthroplasty: A systematic review. Knee 2024; 48:138-149. [PMID: 38642540 DOI: 10.1016/j.knee.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/27/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Intraoperative iatrogenic MCL injuries during primary TKA are rare complications that lack a gold standard management protocol. This review aims to provide insight into various treatment modalities and evidence-based guidance for improved patient outcomes. METHODS A comprehensive search across five databases identified relevant randomized control trials and retrospective cohort studies with reported outcomes. A total of 17 studies were included, and variables such as patient demographics, injury type, management, and Knee Society Scores (KSS) were assessed. The quality of included studies was evaluated using the Critical Appraisal Skills Programme tool. RESULTS Mean age of included patients ranged from 60.0 to 71.4 years. The mean Body Mass Index ranged from 26.75 to 34.40 kg/m2. Among the included knees, 298 were categorized as MCL avulsion, and 167 as midsubstance/transection injuries. Primary repair with sutures or bone staples emerged as the most common management. Intraoperative MCL injury was correlated with reduced preoperative range of motion (ROM) and postoperative KSS clinical, functional, and pain scores compared to control groups. Postoperative ROM was comparable between MCL injury and control groups, ranging from 100.0° to 130.0° and 107.0° to 130.0°, respectively. CONCLUSION Current evidence supports primary repair as the preferred management for this complication. Factors such as extent of the tear, type of injury, and the surgeon's experience also help to guide treatment. While treatment modalities like allograft or autograft reconstruction show promise, further research with larger sample sizes is needed to enhance future outcomes.
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Affiliation(s)
- Dev Dayal
- Michigan State University College of Osteopathic Medicine, Detroit, MI, USA
| | - Abdul K Zalikha
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA.
| | - Mouhanad M El-Othmani
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Rao A, Ratner M, Zhang J, Wiske C, Garg K, Maldonado T, Sadek M, Jacobowitz G, Berland T, Teter K, Rockman C. The substantial burden of iatrogenic vascular injury on the vascular surgery workforce at an academic medical center. J Vasc Surg 2024:S0741-5214(24)01000-0. [PMID: 38641255 DOI: 10.1016/j.jvs.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Vascular surgeons are often called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and in the inpatient setting. The management of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other specialties. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. METHODS This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to May 12, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, was retrospectively collected from February 1, 2022, to October 13, 2022, and prospectively collected for the remainder of the study period. Analyses were performed with R (version 2022.02.03). RESULTS There were 87 patients with consultations related to iatrogenic vascular injury. Of these, 42 (46%) were female and the mean age was 59 years (±18 years). The most common consulting services were cardiology (32%), cardiothoracic surgery (26%), general surgery (8%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (36%), limb ischemia (36%), and treatment of pseudoaneurysm (23%). A total of 24% of consults were intraoperative, 20% of consults related to extracorporeal membrane oxygenation cannulation, and 16% of consults related to ventricular assist devices including left ventricular assist device and intra-aortic balloon pump. The majority of these consult requests (60%) occurred during evening and night hours (5 PM to 7 AM). Emergent intervention was required in 62% of cases and consisted of primary open surgical repair of arterial injury (54%), endovascular intervention (21%), and open thromboembolectomy (15%). Overall, in-hospital mortality for the patient cohort was 20% and the reintervention rate was 23%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. CONCLUSIONS Vascular surgeons play an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. The complications require immediate bedside or intraoperative consult and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to the vascular surgery workforce.
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Affiliation(s)
- Abhishek Rao
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY.
| | - Molly Ratner
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Jason Zhang
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Clay Wiske
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Thomas Maldonado
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Mikel Sadek
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Todd Berland
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Katherine Teter
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
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Fei K, Blakeslee-Carter J, Pearce BJ. Open supraceliac aortic repair of an iatrogenic aortic partial ligation during laparoscopic nephrectomy. J Vasc Surg Cases Innov Tech 2024; 10:101415. [PMID: 38566914 PMCID: PMC10985289 DOI: 10.1016/j.jvscit.2023.101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 04/04/2024] Open
Abstract
Iatrogenic aortic injury is a rare complication of laparoscopic nephrectomy with potentially catastrophic complications. Delays in recognition and treatment contribute significantly to patient morbidity and mortality. We present the case of a patient with acute limb ischemia and mesenteric ischemia secondary to partial transection of the supraceliac aorta during laparoscopic nephrectomy with a staple ligature. The injury was successfully treated with resection of the stapled aorta and reconstruction of a thoracoabdominal aortic bypass with a jump graft to the celiac artery.
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Affiliation(s)
- Kaileen Fei
- Duke University School of Medicine, Durham, NC
| | - Juliet Blakeslee-Carter
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Benjamin J. Pearce
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
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Zhang Z, Tao K, Zhang Y, Xu G. The proper hepatic artery was severed by the linear stapler during modified delta-shaped anastomosis for patients undergoing laparoscopic distal gastrectomy. Asian J Surg 2024; 47:1841-1842. [PMID: 38160159 DOI: 10.1016/j.asjsur.2023.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Zhenxing Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Kelong Tao
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China.
| | - Yu Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Guangen Xu
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China.
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Takei T, Kajiya T, Ninomiya T, Yamamoto K, Imamura K, Atsuchi N. Iatrogenic acute limb ischemia with complete traumatic rupture of the popliteal artery associated with total knee arthroplasty. J Cardiol Cases 2024; 29:193-196. [PMID: 38646080 PMCID: PMC11031660 DOI: 10.1016/j.jccase.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 04/23/2024] Open
Abstract
Acute limb ischemia (ALI) related to total knee arthroplasty (TKA) is rare. Most occlusions are caused by thrombus formation in the popliteal artery (PA). Currently such cases are revascularized using less invasive approaches such as endovascular therapy or Fogarty thrombectomy. We report a case of ALI in a 65-year-old woman with complete rupture of the PA due to a TKA procedure. She had resting pain and motor paralysis in her right lower extremity after TKA. Contrast-enhanced computed tomography showed occlusion of the right femoropopliteal artery. Subsequently, she was referred to our hospital with a diagnosis of ALI. Initially, a less invasive revascularization procedure was unsuccessfully attempted. Therefore, we performed an emergency distal bypass and succeeded in revascularization. Intraoperative examination revealed a complete rupture of the PA. Postoperatively, the patient exhibited no signs of myonephropathic metabolic syndrome. Although there was significant motor impairment, the affected limbs were successfully salvaged. ALI with complete rupture of the PA associated with TKA has not been reported previously. In cases of iatrogenic ALI after TKA, it would be essential to consider diagnostic and revascularization methods that account for the possibility of severe injury to the PA. Learning objective Acute limb ischemia after total knee arthroplasty is a rare and life- and limb-threatening condition. The underlying pathological mechanism is often thrombus occlusion due to mechanical stimuli of the popliteal artery (PA). There are no established treatments for this condition, and less invasive approaches such as endovascular procedures and Fogarty thrombectomy are often used. However, in cases involving severe damage to the PA, bypass surgery may be necessary, and revascularization procedures should be considered accordingly.
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Affiliation(s)
- Tatsuro Takei
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Takashi Kajiya
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Toshiko Ninomiya
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Keisuke Yamamoto
- Department of Cardiovascular Surgery, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Katsuyuki Imamura
- Department of Orthopedic Surgery, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Nobuhiko Atsuchi
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
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8
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Sribhasyam V, Maddikunta S, Hanna B, Hanna A. Accessory head of flexor carpi radialis and abnormal course of the median nerve in the forearm. Surg Neurol Int 2023; 14:411. [PMID: 38213422 PMCID: PMC10783689 DOI: 10.25259/sni_822_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
Background The median nerve anatomy and its clinical presentation are crucial for surgeons to consider avoiding iatrogenic injury and performing effective surgical interventions. Case Description An atypical presentation of median nerve anatomy proximal to the carpal tunnel was found during cadaveric dissection. The median nerve was located deep to a uniquely double-headed flexor carpi radialis and curved medially around the tendons of the forearm to enter the carpal tunnel superficially. Conclusion The atypical presentation of median nerve anatomy can assist surgeons in adverse event reduction during surgeries such as carpal tunnel and pronator teres syndrome releases.
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Affiliation(s)
- Vaishnavi Sribhasyam
- College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Shilpa Maddikunta
- College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Barbara Hanna
- M.D. Program, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States
| | - Amgad Hanna
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, United States
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Lozano-Corona R, Torres-Machorro A, Ortiz-Beitz R, Reyes-Monroy A, García-Lugo I, Ruben-Castillo C, Guerrero-Galindo LA. Review of surgical treatment of iatrogenic iliofemoral artery injury in the pediatric population after catheterization. Eur J Med Res 2023; 28:521. [PMID: 37968770 PMCID: PMC10652633 DOI: 10.1186/s40001-023-01510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/05/2023] [Indexed: 11/17/2023] Open
Abstract
Trauma is the leading cause of death in the pediatric population. Although vascular trauma has an incidence of 6% in civilian population, iatrogenic injuries are the leading cause, and the most frequent injured vessel is the iliofemoral sector. However, little information is available and there are no guidelines about its treatment. Therefore, this review aimed to describe the information available concerning pediatric iatrogenic arterial trauma, focusing on the iliofemoral segment and present 3 cases. We described 11 articles with 171 patients, of whom 61% underwent surgery to treat iatrogenic trauma. Mean age was 3.28 years (standard deviation of 3.5 years), and 54% were female. Most iliofemoral injuries occurred after arterial catheterization for hemodynamic monitorization and therapeutic or diagnostic cardiac catheterization (due to congenital heart diseases, including septal defects, tetralogy of Fallot, aortic coarctation, and patent ductus arteriosus). For acute complications, arterial thrombosis was the leading injury, followed by pseudoaneurysm, hematoma, dissection, transection, avulsion, eversion, and combined lesions.
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Affiliation(s)
- Rodrigo Lozano-Corona
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Unuversidad Av 1321, Zip Code 01030, Mexico City, Mexico.
| | - Adriana Torres-Machorro
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
| | | | - Aristeo Reyes-Monroy
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Unuversidad Av 1321, Zip Code 01030, Mexico City, Mexico
| | - Ignacio García-Lugo
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Unuversidad Av 1321, Zip Code 01030, Mexico City, Mexico
| | - Christopher Ruben-Castillo
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Luis Angel Guerrero-Galindo
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Unuversidad Av 1321, Zip Code 01030, Mexico City, Mexico
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10
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Sun J, Wang R, Chen X, Wang J, Liu D, Sai N, Zhu Y, Liu J, Shen W, Dai P, Yang S, Han D, Han W. Surgical management and the prognosis of iatrogenic facial nerve injury in middle ear surgery: a 20-year experience. Head Face Med 2023; 19:31. [PMID: 37491262 PMCID: PMC10369826 DOI: 10.1186/s13005-023-00377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments. METHODS Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed. RESULTS Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III. CONCLUSIONS Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.
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Affiliation(s)
- Jianbin Sun
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Ruoya Wang
- Department of Otolaryngology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121012, China
| | - Xingrui Chen
- Department of Medical Oncology, Guangdong SanJiu Brain Hospital, Guangzhou, 510510, China
| | - Jianze Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Da Liu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- PLA Air Demonstration Team, Tianjin, 301700, China
| | - Na Sai
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Yuhua Zhu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Jun Liu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Weidong Shen
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Pu Dai
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Shiming Yang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Dongyi Han
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Weiju Han
- Medical School of Chinese PLA, Beijing, 100853, China.
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.
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Zhang L, Li C, Zhang J, Zou D, Dimitriou D, Xing X, Tsai TY, Li P. Significant race and gender differences in anterior cruciate ligament tibial footprint location: a 3D-based analysis. J Orthop Traumatol 2023; 24:33. [PMID: 37389687 DOI: 10.1186/s10195-023-00710-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The aim of the present study was to identify potential race- or gender-specific differences in anterior cruciate ligament (ACL) tibial footprint location from the tibia anatomical coordinate system (tACS) origin, investigate the distances from the tibial footprint to the anterior root of the lateral meniscus (ARLM) and the medial tibial spine (MTS), determine how reliable the ARLM and MTS can be in locating the ACL tibial footprint, and assess the risk of iatrogenic ARLM injuries caused by using reamers with various diameters (7-10 mm). PATIENTS AND METHODS Magnetic resonance images of 91 Chinese and 91 Caucasian subjects were used for the reconstruction of three-dimensional (3D) tibial and ACL tibial footprint models. The anatomical coordinate system was applied to reflect the anatomical locations of scanned samples. RESULTS The average anteroposterior (A/P) tibial footprint location was 17.1 ± 2.3 mm and 20.0 ± 3.4 mm in Chinese and Caucasians, respectively (P < .001). The average mediolateral (M/L) tibial footprint location was 34.2 ± 2.4 mm and 37.4 ± 3.6 mm in Chinese and Caucasians, respectively (P < .001). The average difference between men and women was 2 mm in Chinese and 3.1 mm in Caucasians. The safe zone for tibial tunnel reaming to avoid ARLM injury was 2.2 mm and 1.9 mm away from the central tibial footprint in the Chinese and Caucasians, respectively. The probability of damaging the ARLM by using reamers with various diameters ranged from 0% for Chinese males with a 7 mm reamer to 30% in Caucasian females with a 10 mm reamer. CONCLUSIONS The significant race- and gender-specific differences in the ACL tibial footprint should be taken in consideration during anatomic ACL reconstruction. The ARLM and MTS are reliable intraoperative landmarks for identifying the tibial ACL footprint. Caucasians and females might be more prone to iatrogenic ARLM injury. LEVEL OF EVIDENCE III, cohort study. TRIAL REGISTRATION This study has been approved by the ethical research committee of the General Hospital of Southern Theater Command of PLA under the code: [2019] No.10.
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Affiliation(s)
- Lihang Zhang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Changzhao Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiaying Zhang
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Diyang Zou
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Xing Xing
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, N.W. Washington, DC, USA
- Department of Social Medicine and Health Management, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.
- Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Pingyue Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Ardalı Düzgün S, Ünal E, Çiftçi TT, Öztürk E, Akhan O, Akıncı D. Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome. Diagn Interv Radiol 2023. [PMID: 37272307 DOI: 10.4274/dir.2023.232129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To evaluate the efficacy of interventional radiological (IR) procedures in iatrogenic urinary tract injury and investigate the factors affecting the outcome. METHODS Fifty-eight patients (21 male) with a mean age of 50.3 ± 15.8 years referred for iatrogenic urinary tract injury were enrolled in this study. Technical success was defined as (i) successful placement of a nephrostomy catheter within the renal pelvis and/or (ii) successful antegrade ureteral stent placement (double J stent) between the renal pelvis and bladder lumen. Complete resolution was defined as maintained ureteral patency without an external drain and ureteral stent. The factors that may affect complete resolution [ureteral avulsion, ureterovaginal fistula (UVF), history of malignancy/radiotherapy, and time to IR management] were also investigated. The receiver operating characteristic analysis was performed to estimate the cut-off time point for the IR management timing affecting complete resolution. RESULTS The technical success rate for nephrostomy and ureteral stent placement was 100% (n = 58/58) and 78% (n = 28/36), respectively. In 14 patients, non-dilated pelvicalyceal systems were evident. In 18 patients, no further intervention after percutaneous nephrostomy was performed due to (i) poor performance status (n = 6) and (ii) reconstruction surgery upon clinicians' and/or patients' request (n = 12). Reconstruction surgery was required in 11 of the remaining 40 patients due to failure of percutaneous treatment (n = 11/40, 27.5%). In six of the patients, ureteral stents could not be removed due to the development of benign ureteral strictures (n = 6/40, 15%). Our complete resolution rate was 57.5% (n = 23/40). Age, gender, type of surgery (endoscopic or open), side and location of the injury did not statistically affect the complete resolution rate. The presence of ureteral avulsion, history of malignancy and radiotherapy individually or in combination significantly affected the complete resolution rate negatively. The presence of UVF also had a negative effect on the complete resolution rate; however, it did not reach statistical significance. Delayed intervention was also a significant factor related to lower complete resolution. The optimal cut-off point of the time interval for favorable clinical outcome was found to be 0-19th day following the surgery. CONCLUSION IR procedures are safe and effective in the management of iatrogenic urinary tract injuries. Antegrade ureteral stenting should be performed as soon as possible to establish ureteral integrity without the development of stricture.
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Affiliation(s)
- Selin Ardalı Düzgün
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emre Ünal
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Türkmen Turan Çiftçi
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Öztürk
- Department of Bioistatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Devrim Akıncı
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Guo J, Qi C, Zhang D, Yang G, Wang C, Yang P, Wang B. Safe femoral tunnel drilling angles avoid injury to the medial and posteromedial femoral anatomic structures during single-bundle posterior cruciate ligament reconstruction with the inside-out technique. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07412-0. [PMID: 37039872 DOI: 10.1007/s00167-023-07412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To investigate the relationship between the medial and posteromedial femoral anatomic structures and the femoral tunnel exit produced by different tunnel orientations when creating the femoral tunnel for posterior cruciate ligament reconstruction (PCLR) using the inside-out (IO) technique and to estimate safe tunnel orientations to minimize the risk of iatrogenic injury to these structures. METHODS Eleven cadaveric knees were used. The medial and posteromedial aspects of each knee joint were dissected to reveal the "safe zone," which is a bony area that avoids the distribution or attachment of at-risk structures (MCL, PMC structures, and articular cartilage), while remaining 10 mm away from the articular cartilage. The hypothesis of this study was that by creating the femoral tunnel at specific angles using the IO technique, the tunnel outlet would be as close to the safe zone as possible, protecting the at-risk structures from damage. Femoral tunnels were drilled at 20 different angle combinations on each specimen: 0°, 15°, 30°, 45°, and 60° relative to a line parallel to the transepicondylar axis in the axial plane, as well as 15°, 30°, 45°, and 60° relative to a line parallel to the femoral axis in the coronal plane. The positional relationship between each tunnel exit and the safe zone was recorded, and the shortest distance between the exit center and the safe zone boundary was measured. RESULTS The risk of iatrogenic injury differed depending on the drilling orientation (χ2 = 168.880, P < 0.001). Femoral drilling angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/coronal) were considered relatively safer than other orientations (P < 0.05). The shortest distance between the tunnel exit and the safe zone boundary was negatively correlated with the angle in the axial plane (P < 0.001, r = - 0.810). CONCLUSIONS When creating the IO femoral tunnel for single-bundle PCL reconstruction, angle combinations of 45/45°, 45/60°, 60/30°, 60/45°, and 60/60° (axial/oblique coronal) could be utilized to prevent at-risk structures from being damaged. The drilling angles and the safe zone can be employed to optimize the femoral tunnel in PCLR.
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Affiliation(s)
- Jia Guo
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Guodong Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Bin Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
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Marchese B, McDonald A, McGowan H. The bifurcation and topography of the posterior tibial artery within the tarsal tunnel. Surg Radiol Anat 2023; 45:611-622. [PMID: 36912942 PMCID: PMC10130123 DOI: 10.1007/s00276-023-03115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE The tarsal tunnel (TT) is a fibro-osseous anatomical space coursing from the medial ankle to the medial midfoot. This tunnel acts as a passage for both tendinous and neurovascular structures, including the neurovascular bundle containing the posterior tibial artery (PTA), posterior tibial veins (PTVs) and tibial nerve (TN). Tarsal tunnel syndrome (TTS) is the entrapment neuropathy that describes the compression and irritation of the TN within this space. Iatrogenic injury to the PTA plays a significant role in both the onset and exacerbation of TTS symptoms. The current study aims to produce a method to allow clinicians and surgeons to easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury during treatment of TTS. METHODS Fifteen embalmed cadaveric lower limbs were dissected at the medial ankle region to expose the TT. Various measurements regarding the location of the PTA within the TT were recorded and multiple linear regression analysis performed using RStudio. RESULTS Analysis provided a clear correlation (p < 0.05) between the length of the foot (MH), length of hind-foot (MC) and location of bifurcation of the PTA (MB). Using these measurements, this study developed an equation (MB = 0.3*MH + 0.37*MC - 28.24 mm) to predict the location of bifurcation of the PTA within a 23° arc inferior to the medial malleolus. CONCLUSIONS This study successfully developed a method whereby clinicians and surgeons can easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury that would previously lead to an exacerbation of TTS symptoms.
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Affiliation(s)
- B Marchese
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, 3086, Australia
| | - A McDonald
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - H McGowan
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, 3086, Australia
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Uppada UK, Sinha R. Iatrogenic Mandibular Ramus Fracture Following Surgical Removal of Impacted Third Molar. J Maxillofac Oral Surg 2023; 22:46-48. [PMID: 36703650 PMCID: PMC9871124 DOI: 10.1007/s12663-020-01382-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/05/2020] [Indexed: 01/29/2023] Open
Abstract
Surgical removal of an impacted tooth is considered to be one of the most frequently performed minor oral surgical procedures due to the plethora of indications associated with it. Like any other surgical intervention, the surgical removal of impacted third molars is also associated with numerous complications. Lot of emphasis has been laid to prevent the complications associated with the surgical removal of impacted third molars. However, at times in spite of delivering the utmost caution, complications occur as a consequence of surgical removal of impacted third molars. We report a rare case in which iatrogenic mandibular ramus fracture occurred in an attempt to surgically removal of an impacted third molar.
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Affiliation(s)
- Uday Kiran Uppada
- Department Oral and Maxillofacial Surgery Department, Sri Sai College of Dental Surgery, Vikarabad, India
| | - Ramen Sinha
- Department Oral and Maxillofacial Surgery Department, Sri Sai College of Dental Surgery, Vikarabad, India
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Mazzon G, Smith D, Arumuham V, Celentano G, Bolgeri M, Allen S, Allen C, Choong S. Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries. EUR UROL SUPPL 2023; 49:53-59. [PMID: 36874605 PMCID: PMC9974967 DOI: 10.1016/j.euros.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
Background Complex ureteric strictures and injuries occurring during major abdominal and pelvic operations may cause significant morbidity and distress to patients. A rendezvous procedure is an endoscopic technique used in case of such injuries. Objective To evaluate perioperative and long-term outcomes of rendezvous procedures to treat complex ureteric strictures and injuries. Design setting and participants We retrospectively reviewed patients undergoing a rendezvous procedure for ureteric discontinuity including strictures and injuries, treated between 2003 and 2017 at our Institution and completing at least 12 mo of follow-up. We divided patients into two groups: early postsurgical obstruction, leakage, or detachment (group A) and late strictures (oncological/postsurgical; group B). Outcome measurements and statistical analysis If appropriate, we performed a retrograde study ± rigid ureteroscopy to assess the stricture 3 mo after the rendezvous procedure, followed by a MAG3 renogram at 6 wk, 6 mo, and 12 mo, and annually thereafter for 5 yr. Results and limitations Forty-three patients underwent a rendezvous procedure, 17 in group A (median age 50 yr, range 30-78) and 26 in group B (median age 60 yr, range: 28-83). Ureteric strictures and ureteric discontinuities were stented successfully in 15 out of 17 patients in group A (88.2%) and 22 out of 26 patients (84.6%) in group B. For both groups, the median follow-up was 6 yr. In group A, of 17 patients, 11 (64.7%) were stent free with no further interventions, two (11.7%) had a subsequent Memokath stent insertion (38%), and two (11.7%) required reconstruction. Of 26 patients in group B, eight (30.7%) required no further interventions and were stent free, ten (38.4%) were maintained with long-term stenting, and one was managed with a Memokath stent (3.8%). Of the 26 patients, only three (11.5%) required major reconstruction, while four patients with malignancy (15%) died during follow-up. Conclusions With a combined antegrade and retrograde approach, the majority of complex ureteric strictures/injuries can be bridged and stented with an overall immediate technical success rate of above 80%, avoiding major surgery in unfavourable circumstances and allowing time for stabilisation and recovery of the patient. Additionally, in case of technical success, further interventions may be unnecessary in up to 64% of patients with acute injury and about 31% of patients with late stricture. Patient summary The majority of complex ureteric strictures and injuries can be resolved using a rendezvous approach, avoiding major surgery in unfavourable circumstances. Moreover, this approach can help avoid further interventions in 64% of such patients.
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Affiliation(s)
- Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Vimoshan Arumuham
- Institute of Urology, University College Hospital London, London, UK
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy
- Corresponding author. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy. Tel. +39 081 7462611; Fax: +39 081 7462611.
| | - Marco Bolgeri
- Department of Urology, St George's Hospital, London, UK
| | - Sian Allen
- Institute of Urology, University College Hospital London, London, UK
| | - Clare Allen
- Department of Radiology, University College Hospital London, London, UK
| | - Simon Choong
- Institute of Urology, University College Hospital London, London, UK
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Iwanaga J, Kato T, Ono K, Tubbs RS, Ibaragi S. Lingual nerve impairment/injury after retrieval of the displaced mandibular third molar into the floor of the mouth. Br J Oral Maxillofac Surg 2023; 61:193-197. [PMID: 36813647 DOI: 10.1016/j.bjoms.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/09/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Retrieval of the displaced mandibular third molar in the floor of the mouth is challenging as the lingual nerve is always at risk of injury. However, there are no available data to show the incidence of the injury caused by the retrieval. The goal of this review article is to provide the incidence of the iatrogenic lingual nerve impairment/injury caused by the retrieval based on the review of the existing literature. The retrieval cases were collected with the search words below using PubMed, Google Scholar, and CENTRAL Cochrane Library database on October 6, 2021. A total of 38 cases of lingual nerve impairment/injury in 25 studies were eligible and reviewed. Temporary lingual nerve impairment/injury due to retrieval was found in six cases (15.8%) and all recovered between three to six months after retrieval. General anaesthesia and local anaesthesia were used for retrieval in three cases each. The tooth was retrieved using a lingual mucoperiosteal flap in all six cases. The permanent iatrogenic lingual nerve impairment/injury due to retrieval of the displaced mandibular third molar is considered extremely rare as long as the appropriate surgical approach is chosen based on surgeons' clinical experience and anatomical knowledge.
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Affiliation(s)
- Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Tomotaka Kato
- Division of General Dentistry, Nippon Dental University Hospital, Tokyo, Japan
| | - Kisho Ono
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; University of Queensland, Brisbane, Australia
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Cañas-García I, Gómez-Sánchez J, Santoyo-Villalba J, Mirón-Pozo B. How to avoid iatrogenic injuries of the biliary tract in urgent surgery? The use of indocianine green is an alternative. CIR CIR 2023; 91:713-715. [PMID: 37844892 DOI: 10.24875/ciru.21000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 10/18/2023]
Abstract
Iatrogenic bile duct injury is a rare complication, although feared due to its morbidity and mortality. In urgent surgeries, its incidence can be doubled, so in selected cases we must assess the use of resources such as indocyanine green to minimize the risk of biliary or arterial lesions by allowing the correct identification of the structures. We present the case of a 57-year-old patient with acute cholecystitis who underwent laparoscopic cholecystectomy. Given the difficulty in differentiating structures in Calot's triangle, the decision was made to use indocyanine green, which identifies a very short cystic duct, thus avoiding iatrogenic bile duct injury.
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Affiliation(s)
- Inés Cañas-García
- Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico San Cecilio
| | | | - Julio Santoyo-Villalba
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Las Nieves. Granada, España
| | - Benito Mirón-Pozo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico San Cecilio
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Zhao B, Zhang J, Ma J, Huang M, Li J, Ma X. Comparison of three different treatment methods for traumatic and Iatrogenic peripheral artery pseudoaneurysms. Orthop Surg 2022; 14:1404-1412. [PMID: 35678135 PMCID: PMC9251284 DOI: 10.1111/os.13315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To compare the efficacy of open surgery (OS), endovascular interventions (EIs), and ultrasound‐guided thrombin injection (UGTI) for the treatment of peripheral arterial pseudoaneurysms (PAs). Methods From January 1, 2001, to February 10, 2021, 38 patients diagnosed with traumatic and iatrogenic PAs treated with OS, EI, and UGTI were retrospectively analyzed. There were 18 females and 20 males, with an age of 56.47 ± 14.08 years (range,17–87 years). Anesthesia modality, operation duration, blood transfusion, duration of hospital stay, primary and secondary success rates, and complication rate were used to evaluate the surgical outcomes. Results There were 11 cases under regional anesthesia and 4 under general anesthesia in OS group, 9 under regional anesthesia and 1 under general anesthesia in EI group, and no regional or general anesthesia was required in UGTI group. There was no significant differences between any two groups (χ2 = 39.80, p < 0.05). The blood tranfusion amount (units) were 3.6 ± 6.0, 0.8 ± 2.5, 0.0 ± 0.0 for OS, EI, and UGTI groups, respectively, with significant difference between OS and UGTI groups (F = 3.03, p < 0.05). The operation duration (minutes) of OS, EI, and UGTI groups were 80.0 ± 41.9, 56.0 ± 8.4, and 22.7 ± 5.3, respectively, with significant difference between any two groups (F = 15.69, p < 0.05). The duration of hospital stay (days) were 47.7 ± 39.0, 31.5 ± 17.6, and 16.3 ± 9.5, repectively, with significant difference between any two groups (F = 47.73, p < 0.05). The primary clinical success rates were 80% (12/15), 90% (9/10), and 92.3% (12/13) in OS,EI, and UGTI groups, respectively, with no significant difference between any two groups (χ2 = 0.34, p > 0.05). The secondary clinical success rates were 100% for all three groups. The overall complication rates of OS, EI, and UGTI groups were 20% (3/15), 10% (1/10), and 7.7% (1/13), respectively, with no significant difference between any two groups (χ2 = 1.00, p > 0.05). The infection rates were 13.3% (2/15), 10% (1/10), and 0% (0/13) in OS, EI, and UGTI groups respectively, with no significant difference between any two groups (χ2 = 1.80, p > 0.05). The reintervention rates were 6.7% (1/15), 0% (0/10), 7.7% (1/13) in OS, EI, and UGTI groups, respectively, with no significant difference between two groups (χ2 = 0.95, p > 0.05). Neuralgia was relieved in all patients. Conclusions OS, EI, and UGTI are efficacious and safe options for the treatment of appropriate patients with traumatic and iatrogenic PAs. UGTI would be considered as a first‐line therapy for this condotion.
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Affiliation(s)
- Baocheng Zhao
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinChina
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Jinli Zhang
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Jianxiong Ma
- Biomechanics Research DepartmentBiomechanics Research Institute Affiliated to Tianjin Hospital, Tianjin HospitalTianjinChina
| | - Mei Huang
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Jin Li
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Xinlong Ma
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinChina
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
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Gosslau Y, Warm TD, Foerch S, Zerwes S, Scheurig-Muenkler C, Hyhlik-Duerr A. Iatrogenic injury of the popliteal artery in orthopedic knee surgery: clinical results and development of a therapeutic algorithm. Eur J Trauma Emerg Surg 2022; 48:4169-4179. [PMID: 35359157 PMCID: PMC9532315 DOI: 10.1007/s00068-022-01961-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intraoperative injury to the popliteal artery is a rare complication of orthopedic surgery, however, it can have serious consequences, including major amputation. Recommendations for a standard approach are lacking. The aim of this study was to develop an interdisciplinary therapeutic algorithm to assist in complication management. METHODS From 01/11 to 12/20, 16 arterial injuries after knee surgery were analyzed in a retrospective single-center study. Four cases involved recurrent orthopedic surgery. Procedures performed included eleven total knee arthoplasties (TKA), two TKA replacements, one arthroscopy, and two high tibial osteotomies. Clinical presentation of patients was hemorrhage (n = 2), ischemia (n = 7), the combination of both (n = 4), or pseudoaneurysm formation (n = 3). RESULTS Ten patients underwent endovascular treatment, some as combined procedures: (stent)-PTA (n = 6), aspiration thrombectomy (n = 5), thrombin injection (n = 1), and embolization (n = 1). Six patients were treated surgically: four with bypass/interposition and one with a patch plasty and one as a hybrid procedure, respectively. Only autologous great saphenous vein was used. All extremities could be preserved. Functional impairment remained in six cases. CONCLUSION Both endovascular and surgical procedures can be used to treat arterial injuries after knee surgery. Efficient standardized diagnosis and the involvement of vascular expertise are essential to prevent functional impairment or limb loss, as suggested in the algorithms.
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Affiliation(s)
- Yvonne Gosslau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Tobias Dominik Warm
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Stefan Foerch
- Trauma Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Sebastian Zerwes
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Christian Scheurig-Muenkler
- Diagnostic and interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Alexander Hyhlik-Duerr
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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21
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Gibelli F, Ricci G, Sirignano A, Bailo P, De Leo D. Iatrogenic femoral nerve injuries: Analysis of medico-legal issues through a scoping review approach. Ann Med Surg (Lond) 2021; 72:103055. [PMID: 34815865 DOI: 10.1016/j.amsu.2021.103055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Accidental femoral nerve injury is a well-known iatrogenic complication of orthopaedic, abdominal, and pelvic surgery. Because of the largely transitory nature of the symptoms associated with nerve damage, its true incidence is in all likelihood underestimated. This work aims to illustrate the surgical contexts within which this nerve injury is reported, based on the evidence obtained from a Scoping Review of the literature of the last 20 years, with specific reference to the underlying etiopathogenetic mechanisms and prognostic outcomes, to highlight the evaluation issues of medico-legal interest related to this pathology. Methods We conducted a Scoping Review of iatrogenic femoral nerve injuries reported between 2000 and 2021 by searching the electronic databases Pubmed, Scopus, Ovid Medline, Ovid Emcare, and Web of Science.We conducted the review according to the five-step methodology outlined by Arksey and O'Malley. Results The literature search identified 104 papers, including case reports, case series, and retrospective studies. Surgical contexts within which iatrogenic femoral nerve injuries were reported include orthopaedic, abdominal, gynaecological, urological, vascular, and plastic surgery, as well as locoregional anaesthesiological procedures. The long-term prognosis was generally favourable. Conclusions Because of its frequent iatrogenic genesis, femoral nerve injury is a topic of intense medico-legal interest. From the perspective of estimating the patient's disability, the mostly favourable nature of the prognosis makes the medico-legal assessment, in some respects, complex, thus requiring a precise evaluation methodology.
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Szwedowski D, Ambroży J, Grabowski R, Dallo I, Mobasheri A. Diagnosis and treatment of the most common neuropathies following knee injuries and reconstructive surgery - A narrative review. Heliyon 2021; 7:e08032. [PMID: 34611563 PMCID: PMC8477214 DOI: 10.1016/j.heliyon.2021.e08032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 01/09/2023] Open
Abstract
The main nerves in the knee region are the tibial nerve, the common peroneal nerve, and the saphenous nerve. These three nerves innervate the lower leg and foot, providing sensory and motor function. The large sciatic nerve splits just above the knee to form the tibial and common peroneal nerves. The tibial nerve travels down in the posterior region, while the common peroneal nerve runs around the lateral side of the knee and runs down the front of the leg to the foot. Although all these nerves can be affected by injuries of the knee, the infrapatellar branch of the saphenous nerve (IPBSN) and the common peroneal nerve (CPN) are most affected. In this narrative review we focus on neuropathies associated with nerves located in the region of the knee joint in the context of their injuries and possible iatrogenic damage during reconstructive surgery.
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Affiliation(s)
- Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy
| | - Jarosław Ambroży
- Lesser Poland Orthopedic and Rehabilitation Hospital, Krakow, Poland
| | - Radosław Grabowski
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy
- Department of Orthopaedics and Traumatology, Medical University of Lodz, Lodz, Poland
| | - Ignacio Dallo
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. Ann Transl Med 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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Pan X, Yao Y, Yan H, Wang J, Dai L, Qu X, Fang Z, Feng F, Zhou Y. Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes. Eur J Med Res 2021; 26:73. [PMID: 34247652 PMCID: PMC8274043 DOI: 10.1186/s40001-021-00545-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. METHODS A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. RESULTS A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29-86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48-86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12-36 months). The mean Neer scores were 80.5 ± 7.6 (range 62-93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1-6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). CONCLUSION A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.
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Affiliation(s)
- Xiaohui Pan
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yong Yao
- Department of Orthopedics, The Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, 445000, Hubei, People's Republic of China
| | - Hongyong Yan
- Department of Orthopedics, Jiangxia District Hospital of Traditional Chinese Medicine, Jiangxia, 430200, Hubei, People's Republic of China
| | - Jun Wang
- Department of Orthopedics, Huangshi Second People's Hospital, Huangshi, 435000, Hubei, People's Republic of China
| | - Lei Dai
- Department of Orthopedics, Huangmei County Hospital of Traditional Chinese Medicine, Huangmei, 438500, Hubei, People's Republic of China
| | - Xincong Qu
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Zuyi Fang
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Feng Feng
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yan Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
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Zheng HX, Lee YL, Chen GY, Hung YC. Iatrogenic pseudoaneurysm of the superficial temporal artery following craniectomy from a scalp hook retractor penetrating injury: Case report and literature review. Int J Surg Case Rep 2021; 84:106076. [PMID: 34157547 PMCID: PMC8220550 DOI: 10.1016/j.ijscr.2021.106076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Iatrogenic pseudoaneurysms in scalp vessels are an uncommon complication after cranial surgery. This paper reports a case of scalp pseudoaneurysm in the superficial temporal artery (STA) after forceful hook retraction in craniectomy and reviews the relevant literature. Case description A 36-year-old man with history of hypertension and depression presented to the emergency department with head injury after using sedation medication. Brain computed tomography (CT) revealed a 2-cm-thick right parietal extradural hematoma (EDH) with parietal skull fracture, a bilateral lower frontotemporal contusional intracerebral hematoma, diffuse subarachnoid hemorrhage, and a right frontotemporoparietal subdural hematoma. To prevent EDH progression, frontotemporal emergency craniectomy to remove the EDH was performed. The next day, a firm, painful mass measuring 3 × 3.5 cm2 was discovered over the right frontal scalp. The mass was close to the site where the scalp hook retractor had been placed during surgery. Sonography revealed pulsatile blood flow with an arterial feeder inside the mass. CT angiography revealed a 1 × 1.2 × 0.7 cm3 pseudoaneurysm in the right frontal scalp from the frontal branch of the STA. We scheduled a resection of the pseudoaneurysm and combined cranioplasty on the 29th postoperative day. The pseudoaneurysm was resected en bloc. The patient was discharged with clear consciousness and intact muscle power. Conclusion The complications of STA pseudoaneurysms caused by scalp hook retractors are rare and not yet well reported. Surgeons must avoid injuring the STA when using a scalp hook retractor. A scalp pseudoaneurysm should be suspected when a postoperative mass is noted along the STA after scalp hook retractor use. Preoperative use of a Doppler vascular detector can help surgeons mark the course of the STA and its branches. Surgeons must avoid injury to the STA when using a scalp hook retractor.
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Affiliation(s)
- Hong-Xiang Zheng
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yao-Lin Lee
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Guan-Yu Chen
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yi-Chieh Hung
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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Naga ANE, Tavolaro C, Agel J, Zhou H, Bellabarba C, Bransford RJ. Incidence and degrees of neurologic decline following thoracic costotransversectomy. Spine J 2021; 21:937-944. [PMID: 33453386 DOI: 10.1016/j.spinee.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Thoracic costotransversectomies (TCT) are amongst the most invasive spine procedures performed. Of greatest concern to the patient and surgeon is the risk of iatrogenic neurologic injury associated with these procedures. Most available studies limit their assessment of neurologic function to nonspecific scales such as the broader ASIA scoring system of A to E and have not comprehensively described the rates of iatrogenic injury following these procedures by looking more precisely with ASIA motor scoring (0-100) which allows for more in-depth analysis. PURPOSE The purpose of this study is to investigate the rates and degree of iatrogenic neurologic decline following TCT and subsequent rates and degree of motor recovery. STUDY DESIGN/SETTING Retrospective medical record review at a single institution. PATIENT SAMPLE Around 116 consecutive patients undergoing TCT operations. OUTCOME MEASURES Neurological changes from preprocedure to final follow-up assessed by lower extremity motor score. METHODS A retrospective chart review of patients undergoing TCT between May 2008 and April 2018 was carried out. Clinical, surgical, and intraoperative neuromonitoring data were collected. Patients who demonstrated an initial postoperative decline in lower extremity motor scores (LEMS) were followed through their final follow up to assess recovery. RESULTS Around 116 patients underwent TCT between T2 and T12 between May 2008 and April 2018. Seven (6.0%) patients demonstrated an immediate postoperative decline as defined by a drop of more than 4 points (mean 15.1; range 5-50) in motor score. All patients who demonstrated an initial postoperative motor score decline returned to within 4 LEMS points of their preoperative LEMS by final follow up. IOMN changes were noted only in half of all monitored patients who were noted to have a decline. CONCLUSIONS In our series, 6.0% of patients undergoing TCT experienced an initial decline in motor score with 94.0% demonstrating an unchanged or improved examination compared to preoperative exam. In our series, all patients who exhibited a decline recovered to within 4 points of the preoperative motor score within the first year postoperatively.
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Affiliation(s)
- Ashraf N El Naga
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Celeste Tavolaro
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Julie Agel
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Haitao Zhou
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Carlo Bellabarba
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA
| | - Richard J Bransford
- Department of Orthopaedics & Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA.
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Mazzeo C, Viscosi F, Badessi G, Cucinotta E. A critical view of safety in left colectomy surgery: A case of renal artery injury. Int J Surg Case Rep 2021; 83:106035. [PMID: 34090189 PMCID: PMC8188329 DOI: 10.1016/j.ijscr.2021.106035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The standardization of the laparoscopic approach in left hemicolectomy was facilitated by the vascular anatomy of the left colon, which has few anatomical variants. The current technique for left hemicolectomy consists in approaching the inferior mesenteric artery (IMA), after identification of the inferior mesenteric vein (IMV), from above (craniocaudal) or from below (caudocranial). The type of approach is decided on the basis of the vascular window between the IMV and IMA. However, vascular abnormalities of adjacent organs can call into question the steps of the standardized technique. Case presentation We describe a case of iatrogenic left renal artery injury caused during left laparoscopic hemicolectomy due to an abnormality of the renal vessels. The artery originated from the aorta more caudally than usual with respect to the normal population. Discussion What happened made us question the security of the standardized approach in practice, especially in patients with vascular anomalies. The use of advanced imaging programs, such as 3D reconstruction, can help to prevent iatrogenic damages, but not all hospitals have such technology, especially in rural areas. Conclusion We propose, to further decrease the risk of iatrogenic injuries, a “critical view of safety” for left colic surgery, in which, before any potential arterial resection, a careful craniocaudal and caudocranial dissection of the Toldt-Gerota plane could be useful in identifying the IMA at the center of this plane. Moreover, a preoperative imaging study is of paramount importance in all surgical procedures. The anatomical variations of the left renal vessels may be the cause of iatrogenic vascular lesions in left hemicolectomy. Advanced imaging programs and preoperative study can help prevent iatrogenic injuries A careful cranio-caudal and caudo-cranial dissection of the Toldt-Gerota plane could identify the inferior mesenteric artery.
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Affiliation(s)
- Carmelo Mazzeo
- Department of General and Emergency Surgery, Policlinico G. Martino, University of Messina, Italy
| | - Francesca Viscosi
- Department of General and Emergency Surgery, Policlinico G. Martino, University of Messina, Italy
| | - Giorgio Badessi
- Department of General and Emergency Surgery, Policlinico G. Martino, University of Messina, Italy.
| | - Eugenio Cucinotta
- Department of General and Emergency Surgery, Policlinico G. Martino, University of Messina, Italy
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Abstract
BACKGROUND The laparoscopic view of extrahepatic biliary tract and cystic artery is different anatomically from open approach. Consequently iatrogenic injuries due to inadverent damage to cystic artery are not uncommon. These complications can be prevented by careful dissection in Calots triangle and better knowledge of laparoscopic anatomy of cystic artery and its variations. The aim of this study is to establish the prevalence of variation in position of cystic artery in relation to cystic duct. This will help identify the safe area for dissecting peritoneum in Calots triangle and thus help young surgeons overcome the long learning curve associated with laparoscopy. MATERIALS AND METHODS During a 10 year period from January 2009 to January 2019, 1850 laparoscopic cholecystectomies that were performed at a tertiary care hospital were studied. Patients with history of previous abdominal surgery were excluded from the study. Cystic artery was divided into four groups based on its relative position to cystic duct. It includes superomedial, superolateral, anterior and absent cystic artery relative to the cystic duct. RESULTS Out of 1850 cases of laparoscopic cholecystectomy 1676 (90.59%) patients had cystic artery superomedial to cystic duct and 96 (5.19%) had a cystic artery at superolateral position to cystic duct. In 48 (2.59%) patients it was found anterior to cystic duct and in 30 (1.62%) patients it was absent. CONCLUSIONS It is concluded that the most common position of cystic artery is superomedial while the least common position was found to be anterior to cystic duct. Hence it is postulated that blind dissection from anterior side is the safest approach to avoid injury to cystic artery.
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Affiliation(s)
- Omer Fateh
- Department of Surgery, Sindh Government Qatar Hospital, Karachi, Pakistan
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Pandian V, Brodsky MB, Brigham EP, Parker AM, Hillel AT, Levy JM, Rassekh CH, Lalwani AK, Needham DM, Brenner MJ. COVID-19 survivorship: How otolaryngologist-head and neck surgeons can restore quality of life after critical illness. Am J Otolaryngol 2021; 42:102917. [PMID: 33545448 DOI: 10.1016/j.amjoto.2021.102917] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/05/2023]
Abstract
Mortality from COVID-19 has obscured a subtler crisis – the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care syndrome (PICS), which encompasses physical, cognitive, and/or mental health impairments that are often long-lasting barriers to resuming a meaningful life. Some deficits after COVID-19 critical illness will require otolaryngologic expertise for years after hospital discharge. There are roles for all subspecialties in preventing, diagnosing, or treating sequelae of COVID-19. Otolaryngologist leadership in multidisciplinary efforts ensures coordinated care. Timely tracheostomy, when indicated, may shorten the course of intensive care unit stay and thereby potentially reduce the impairments associated with PICS. Otolaryngologists can provide expertise in olfactory disorders; thrombotic sequelae of hearing loss and vertigo; and laryngotracheal injuries that impair speech, voice, swallowing, communication, and breathing. In the aftermath of severe COVID-19, otolaryngologists are poised to lead efforts in early identification and intervention for impairments affecting patients' quality of life.
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Omotoso BR, Harrichandparsad R, Moodley IG, Satyapal KS, Lazarus L. An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population. Surg Radiol Anat 2021; 43:929-941. [PMID: 33689007 PMCID: PMC8164601 DOI: 10.1007/s00276-021-02712-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
Introduction The most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addition to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population. Materials and methods The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019. Results The VA exhibited morphological variation in its course. We report the incidence of variant origin of the left VA, all from the aortic arch. Variation in the level of entry into the transverse foramen ranged between C7 and C3. A left dominant pattern was observed; we also report on hypoplasia of the VA. In addition, we report incidence of VA tortuosity at V1, V2 to be 76.6% and 32.1%, respectively. Conclusions The baseline data established in this study regarding the diameter, variant origin, and level of entry into the transverse foramen will assist neurosurgeons and interventional radiologists in interpreting, diagnosing, and planning and executing various vascular procedures and treatment of pathology in the vicinity of the VA.
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Affiliation(s)
- B R Omotoso
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - R Harrichandparsad
- Department of Neurosurgery, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - I G Moodley
- Department of Radiology, Jackpersad and Partners Inc, Specialist Diagnostic Radiologists, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - K S Satyapal
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - L Lazarus
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
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Peng J, McKissack H, Yu J, He JK, Montgomery T, Moraes L, Alexander B, Shah A. Anatomic structures at risk in anteroposterior screw fixation of posterior malleolar fractures: A cadaver study. Foot Ankle Surg 2021; 27:162-167. [PMID: 32381450 DOI: 10.1016/j.fas.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Percutaneous anterior-posterior (AP) screw is an option for posterior malleolus fracture fixation when the fracture fragment can be reduced indirectly by the mean of ligamentotaxis. However, anterior anatomic structures could be injured during screw placement. MATERIALS AND METHODS Eleven below-knee cadavers were employed for the placement of AP screws in an attempt of fixing assumed Haraguchi Type-I posterior malleolar fractures. Three entry points were selected as medial to the anterior tibial tendon (ATT), lateral to the ATT, and lateral to the extensor digitorum longus (EDL). Three AP screws were placed under guidance of fluoroscopy. After dissection, measurements were made (mm) from each screw to nearby structures. Distances were calculated and damage to structures was documented. RESULTS Mean, minimum, and maximum distances from the medial screw to the greater saphenous vein, TA, EHL, anterior tibial artery (ATA), and deep peroneal nerve (DPN), were 18.1 (12-25) mm, 2.0 (0-5) mm, 13.6 (9-20) mm, 16.6 (9-25) mm, and 20.1 (12-27) mm. From the middle screw to the ATA, DPN, TA, EHL, and EDL, were 1.2 (0-3) mm, 4.9 (3-9) mm, 3.8 (1-7) mm, 0.4 (0-2) mm, and 13.6 (10-18) mm. From the lateral screw to the superficial peroneal nerve (SPN), EDL, DPN, and ATA, were 10.8 (0-16) mm, 1.2 (0-4) mm, 15.9 (11-25) mm, 19 (15-27) mm. The SPN was found partially cut by the lateral screw on 1 specimen. CONCLUSIONS Lateral and middle percutaneous AP screw placement put certain anatomic structures at-risk of injury. Medial screw placement did not result in appreciable damage to adjacent structures. Entry point of AP screws should be selected with respect to posterior malleolar fracture and anatomic structures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jianguang Peng
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haley McKissack
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jonathan Yu
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jun Kit He
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tyler Montgomery
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Leonardo Moraes
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Bradley Alexander
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
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Dubuisson A, Kaschten B, Steinmetz M, Gérardy F, Lombard A, Dewandre Q, Reuter G. Iatrogenic nerve injuries: a potentially serious medical and medicolegal problem. About a series of 42 patients and review of the literature. Acta Neurol Belg 2021; 121:119-124. [PMID: 32651878 DOI: 10.1007/s13760-020-01424-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the management of iatrogenic nerve injuries (iNI) in 42 patients. METHODS Retrospective analysis of the charts. RESULTS The iNI occurred mostly during a surgical procedure (n = 39), either on a nerve or plexus (n = 13), on bone, joint, vessel or soft tissue (n = 24) or because of malpositioning (n = 2). The most commonly injured nerves were the brachial plexus, radial, sciatic, femoral, or peroneal nerves. 42.9% of the patients were referred later than 6 months. A neurological deficit was present in 37 patients and neuropathic pain in 17. Two patients were lost to follow-up. Conservative treatment was applied in 23 patients because of good spontaneous recovery or compensation or because of expected bad prognosis whatever the treatment. Surgical treatment was performed in 17 patients because of known nerve section (n = 2), persistent neurological deficit (n = 12) or invalidating neuropathic pain (n = 3); nerve reconstruction with grafts (n = 8) and neurolysis (n = 8) were the most common procedures. Outcome was satisfactory in 50%. Potential reasons of poor outcome were a very proximal injury, placement of very long grafts, delayed referral and predominance of neuropathic pain. According to the literature delayed referral of iNI for treatment is frequent. We provide an illustrative case of a young girl operated on at 6.5 months for femoral nerve reconstruction with grafts while nerve section was obvious from the operative note and pathological tissue analysis. Litigation claims (n = 10) resulted in malpractice (n = 2) or therapeutic alea (n = 5) (3 unavailable conclusions). i CONCLUSIONS: NI can result in considerable disability, pain and litigation. Optimal management is required.
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Wei YH, Shi BM. Diagnosis, treatment, and prevention of iatrogenic injury at the biliary-pancreatic-enteric junction. Shijie Huaren Xiaohua Zazhi 2021; 29:29-33. [DOI: 10.11569/wcjd.v29.i1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The biliary-pancreatic-enteric junction is prone to a variety of diseases, including calculi, inflammatory thickening, and tumors, which are easy to cause stenosis or obstruction and need timely treatment. Due to the complex anatomy and unique pathophysiological characteristics of the site, iatrogenic injuries are easy to occur during various examinations or treatment operations, and the injuries are often hidden and not easy to find intraoperatively. If not treated early, the injuries often cause serious consequences with a high mortality. Therefore, it is of great significance to study the causes, diagnosis, treatment, and prevention of iatrogenic injury at the biliopancreatic junction. This article will discuss the prevention, diagnosis, and treatment of iatrogenic injury at the biliary-pancreatic-enteric junction and summarize our diagnosis and treatment experience.
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Affiliation(s)
- Yu-Hua Wei
- Department of General Surgery, Tongji Affiliated Hospital of Tongji University, Shanghai 200065, China
| | - Bao-Min Shi
- Department of General Surgery, Tongji Affiliated Hospital of Tongji University, Shanghai 200065, China
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Devendra A, Nishith PG, Velmurugesan P, Venkatramani H, Dheenadhayalan J, Rajasekaran S. Surgical management of peripheral artery pseudoaneurysm following orthopedic trauma: a report of 14 cases. Eur J Trauma Emerg Surg 2020. [PMID: 33226483 DOI: 10.1007/s00068-020-01546-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Purpose of this study was to report the etiology, diagnosis, surgical management, and outcome of pseudoaneurysm associated with orthopedic trauma. METHODS A retrospective review was conducted of all patients presenting to a Level 1 trauma center between 2013 and 2019. Clinical records were reviewed for the mechanism of primary injury, associated fracture pattern, time of presentation, site of involvement, etiology of the pseudoaneurysm, diagnosis, management, and complications. We identified 14 patients with pseudoaneurysm of peripheral arteries following orthopedic trauma. RESULTS The mean interval between primary injury and the manifestation of clinical symptoms was 88.5 days (range, 16-304 days). There were 3 upper limb injuries and 11 lower limb injuries. The presenting symptoms were pain associated with excessive extremity swelling in most of the patients. A significant drop in hemoglobin (mean fall- 2.9 g/dL) was noted in nine patients. Most common artery involved was the superficial branch of femoral artery and posterior tibial artery followed by the brachial artery. Fractured bone spike was the cause of injury in eight patients and iatrogenic injury in six patients. Diagnosis was confirmed by CT angiography with duplex scan in eight patients, duplex scan alone in one patient, MRI along with duplex scan in one patient. The remaining four patients were diagnosed intraoperatively. Excision of the pseudoaneurysm and ligation of the involved minor arteries was done in eight patients. Surgical repair of the major artery with critical vascular injury was done in six patients. One patient underwent secondary amputation following the anastomotic blowout. CONCLUSION Early diagnosis of pseudoaneurysm requires knowledge and a high index of suspicion. Surgical reconstruction of major arteries should always be done and ligation of major vessels can lead to catastrophes. Excision of pseudoaneurysm can be done when minor arteries are involved with the presence of good collateral circulation. LEVEL OF STUDY Level IV Study.
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Poon SS, George J, Obaid D, Kumar P. Myocardial infarction and ventricular fibrillation due to iatrogenic right coronary artery occlusion following tricuspid valve annuloplasty: a case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33442598 PMCID: PMC7793041 DOI: 10.1093/ehjcr/ytaa328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/11/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022]
Abstract
Background Iatrogenic right coronary artery (RCA) injury is a rare complication of tricuspid valve annuloplasty. Given that surgical intervention is increasingly favoured for tricuspid regurgitation, it is of great importance to recognize potential complications following tricuspid valve surgery. Case summary A 72-year-old man underwent surgical mitral and tricuspid valve repair. The early post-operative course was complicated by recurrent ventricular fibrillation episodes. Due to haemodynamic instability, a re-sternotomy and another cardiopulmonary bypass run were required. The patient subsequently underwent coronary angiography study which confirmed RCA occlusion. The occluded posterior left ventricular (PLV) branch was reopened by balloon angioplasty. However, despite multiple attempts it was not possible to pass a coronary guide wire into the posterior descending artery (PDA). An intravascular ultrasound examination revealed that the ostium of the PDA was compressed by external factors leaving a narrow slit-like appearance with no accessible lumen. Subsequently, a drug-eluting stent was placed into the PLV branch. The PDA was not accessible on repeated re-canalization attempts. The patient later successfully recovered from the right ventricular myocardial infarction. Discussion Right coronary artery occlusion should be considered as a differential diagnosis for significant rhythm disturbances and haemodynamic instability in the peri- and post-operative period following tricuspid valve annuloplasty. A low threshold for diagnostic angiography is needed to avoid potential delay in life-saving revascularization.
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Affiliation(s)
- Shi Sum Poon
- Department of Cardiac Surgery, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, UK
| | - Joseph George
- Department of Cardiac Surgery, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, UK
| | - Daniel Obaid
- Department of Interventional Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, UK
| | - Pankaj Kumar
- Department of Cardiac Surgery, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, UK
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Wang J, Fan HQ, Dai W, Li HD, Fu YP, Liu Z, Huang CM, Shi Z. Safety of the application of Rigidfix cross-pin system via different tibial tunnels for tibial fixation during anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2020; 21:736. [PMID: 33176762 PMCID: PMC7661174 DOI: 10.1186/s12891-020-03645-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We investigate the safety of the application of the Rigidfix cross-pin system via different tibial tunnels in the tibial fixation during anterior cruciate ligament (ACL) reconstruction. METHODS Five adult fresh cadaver knees were fixed with the Rigidfix cross-pins in the tibial fixation site during ACL reconstruction. Two different tibial tunnel groups were established: in group A, the tunnel external aperture was placed at the 25° angle of coronal section; in group B, the tunnel external aperture was placed at the 45° angle of coronal section. The guide was placed at the plane 0.5 mm below articular facet through the tibial tunnel, with three rotation positions set at 0°, 30°, and 60° slopes. The incidences of iatrogenic injuries at tibial plateau cartilage (TPC), medial collateral ligament (MCL), and patellar tendon in three different slope angles were calculated in groups A and B and the results were analyzed by using chi square test. RESULTS The iatrogenic injuries at MCL, TPC, and patellar tendon could occur after the Rigidfix cross-pin system was placed 5 mm below tibial plateau cartilage for ACL reconstruction. The incidences of TPC injury (χ2 = 5.662, P = 0.017) and MCL injury (P = 0.048, Fisher exact probability method) were significantly lower in group A than in group B. However, the incidence of patellar tendon injury showed no significant difference between these two groups (χ2 = 0.120, P = 0.729). CONCLUSIONS When the Rigidfix cross-pin system is used for ACL reconstruction at the tibial fixation site, the external aperture of tibial tunnel should not be placed at the excessively posterosuperior site, to avoid MCL and TPC injuries.
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Affiliation(s)
- Jian Wang
- Department of Orthopaedic Surgery, Nanfang hospital, Southern Medical University, Guangdong, 510515, People's Republic of China
| | - Hua-Qiang Fan
- Department of Orthopaedic Surgery, Chenggong Hospital Affiliated to Xiamen University, Xiamen, 361003, Fujian Province, People's Republic of China
| | - Wenli Dai
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Hong-Da Li
- Department of Orthopaedic Surgery, Chenggong Hospital Affiliated to Xiamen University, Xiamen, 361003, Fujian Province, People's Republic of China
| | - Yang-Pan Fu
- Department of Orthopaedic Surgery, Chenggong Hospital Affiliated to Xiamen University, Xiamen, 361003, Fujian Province, People's Republic of China
| | - Zhenhuang Liu
- Department of Orthopaedic Surgery, Chenggong Hospital Affiliated to Xiamen University, Xiamen, 361003, Fujian Province, People's Republic of China
| | - Chang-Ming Huang
- Department of Orthopaedic Surgery, Chenggong Hospital Affiliated to Xiamen University, Xiamen, 361003, Fujian Province, People's Republic of China
| | - Zhanjun Shi
- Department of Orthopaedic Surgery, Nanfang hospital, Southern Medical University, Guangdong, 510515, People's Republic of China.
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Miura K, Komiya T, Shimamoto T, Matsuo T. How far is the left circumflex coronary artery from the mitral annulus? Gen Thorac Cardiovasc Surg 2020; 68:1447-1452. [PMID: 33029760 DOI: 10.1007/s11748-020-01493-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The relationship between the distance from the mitral annulus to the left circumflex coronary artery (LCX) and iatrogenic LCX injury has been questioned. This study was designed to determine the high-risk sites of LCX injury with an anatomical approach using multiple detector-computed tomography (MDCT) scanning taken before mitral valve annuloplasty (MVA). The purpose of this study is to prevent LCX injury in patients unable to receive MDCT before mitral valve surgery. METHODS In 2018, we performed MVA on 59 patients, 52 of whom had undergone preoperative MDCT scanning. We retrospectively analyzed the MDCT images of these 52 patients and measured the shortest distance from the mitral annulus to the LCX in three dimensions. Also, we divided the mitral annulus into 12 clockwise areas (A0-A11) to identify the exact location. RESULTS The site of closest proximity and their numbers of patients were as follows: A6, 1 patient; A8, 2 patients; A9, 32 patients; and A10, 17 patients. Nine (17.3%) of the 52 patients had the shortest distance of less than 2 mm. The shortest distance according to the dominance of coronary artery showed no significant difference (p = 0.81). CONCLUSION The site of closest proximity from the mitral annulus to the LCX was concentrated on the A8 to A10 areas and it is an interesting result that as many as 17% of patients have their coronary arteries less than 2 mm away from the annulus.
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Affiliation(s)
- Koji Miura
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Takehiko Matsuo
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
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Rhatomy S, Yudhistira JF, Soekarno NR, Setyawan R. Iatrogenic injury of posterolateral structures during femoral tunneling in anterior cruciate ligament reconstruction: A cadaveric study. Ann Med Surg (Lond) 2020; 59:14-16. [PMID: 32983441 PMCID: PMC7494821 DOI: 10.1016/j.amsu.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Creating Femoral tunnel in Anterior Cruciate Ligament (ACL) reconstruction can be done through some portal. Transportal technique commonly preferred by Orthopedic Surgeon. However, this technique may possess some iatrogenic injury to knee structure especially in the posterolateral during the drilling. This study aim is to describe the most susceptible injured posterolateral structure of the knee during femoral tunneling from trans portal technique Anterior Cruciate Ligament (ACL) reconstruction. Methods Twenty knees from ten cadavers was examined. Anterior Cruciate Ligament (ACL) reconstruction was simulated using the trans portal technique. Femoral drilling was performed with knee in 120 flexion. The cadaver was dissected to identify the injured posterolateral structure during femoral tunneling. The data collected was anatomy structure and the wound size. Results All Twenty knees were included in the study. 90% of injured structure was iliotibial band. The next most common was plantaris (50%) dan gastrocnemius (45%) muscle. The other was biceps femoris muscle (20%). The least common injury was vastus lateralis (5%). No injury was observed in Lateral Collateral Ligament (LCL), popliteus tendon, and peroneal nerve. Conclusion Transportal technique during femoral drilling in Anterior Cruciate Ligament (ACL) reconstruction does do damage to some of the posterolateral structure. The injury was considered minimal and may not result in function deterioration. There is also no risk to common peroneal nerve. Iatrogenic Injury. Posterolateral Structures. Femoral Tunneling. Anterior Cruciate Ligament Reconstruction. Cadaveric Study.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia/ Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jaka Fatria Yudhistira
- Department of Orthopaedics and Traumatology, Radjak Hospital, Salemba, Jakarta, Indonesia
| | | | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia/ Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Abstract
With the advent of parenteral, intravenous infusion for various purposes like chemotherapy, parenteral nutrition, radiocontrast intravenous injection for imaging studies, extravasation injuries are emerging as a serious problem with often disastrous complications, if not recognized early. Fortunately, if treated early, the affected extremities can be salvaged and hence the role of plastic surgeons cannot be over-emphasized, especially when it comes to the reconstruction of necrotic and ischemic wounds as a result of these injuries. Proper monitoring and immediate intervention will go a long way in minimizing the morbidity associated with these injuries. However, if there is a delay in recognition and treatment, it can lead to complications like skin necrosis, gangrene, extensive soft tissue defects and contractures. Treatment in these circumstances needs an individualized approach and entails wound debridement followed by skin grafts and flap cover. Documentation and prompt intervention can avoid medicolegal issues for the physician and the hospital.
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Affiliation(s)
- Leon Alexander
- Sheikh Khalifa Medical City, Division of Plastic Surgery, Department of Surgery, Abu Dhabi, UAE
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Liu D, Wang Y, Zheng Y, Wang FQ. Rapid on-site evaluation of pulmonary cryptococcosis: A preliminary assessment. Asian J Surg 2020; 43:1097-1098. [PMID: 32839084 DOI: 10.1016/j.asjsur.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Dan Liu
- Department of Thoracic Surgery, The West China Hospital of Sichuan University, Chengdu, 610017, China; The First Department of Surgery, The Traditional Chinese Medicine Hospital, Anyue City, 642350, Sichuan Province, China
| | - Yun Wang
- Department of Thoracic Surgery, The West China Hospital of Sichuan University, Chengdu, 610017, China.
| | - Yu Zheng
- Department of Thoracic Surgery, The West China Hospital of Sichuan University, Chengdu, 610017, China
| | - Fu-Qiang Wang
- Department of Thoracic Surgery, The West China Hospital of Sichuan University, Chengdu, 610017, China
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Yi JA, Hadley JB, Kuwayama DP. Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair. J Vasc Surg Cases Innov Tech 2020; 6:397-400. [PMID: 32715178 PMCID: PMC7369519 DOI: 10.1016/j.jvscit.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
May-Thurner syndrome is characterized by unilateral lower extremity venous hypertension and stasis due to compression of an iliac vein between an iliac artery and the lumbar spine. In almost all cases, the left common iliac vein is compressed by the right common iliac artery; however, other patterns have been described. Rarely, May-Thurner syndrome may be created iatrogenically as a result of iliac artery stenting. We present an unusual case of new left common iliac vein thrombosis caused by ipsilateral left iliac artery compression after aortobi-iliac endovascular aneurysm repair.
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Affiliation(s)
- Jeniann A Yi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Aurora, Colo
| | - Jamie B Hadley
- Department of Surgery, University of Colorado, Aurora, Colo
| | - David P Kuwayama
- Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Choi JU, Hwang S, Chung YK. Management of intractable pancreatic leak from iatrogenic pancreatic duct injury following resection of choledochal cyst in an adult patient. Ann Hepatobiliary Pancreat Surg 2020; 24:228-233. [PMID: 32457272 PMCID: PMC7271105 DOI: 10.14701/ahbps.2020.24.2.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022] Open
Abstract
Iatrogenic pancreatic duct injury can occur during resection of the choledochal cyst (CC). We herein present a case of postoperative pancreatic fistula (POPF) developed after resection of the CC in an adult patient with variant anomalous union of pancreatobiliary duct. The 55-year-old female patient underwent surgery after the diagnosis of CC-associated gallbladder cancer. During surgery, the CC mass was accidentally pulled out, by which the intrapancreatic CC portion was torn out from the main pancreatic duct. Since the pancreatic duct stump was not identified due to its small size, repair was not possible. The excavated defect at the pancreas head was closed securely combined with insertion of multiple drains. Postoperative POPF and peripancreatic fluid collection developed and the patient had to be fasted for 4 weeks. She was first discharged at 6 weeks after surgery. At 10 weeks, she was readmitted due to progression of peripancreatic fluid collection, which was controlled by percutaneous drain insertion. At 6 months, she was readmitted again due to repeated progression of peripancreatic fluid collection, which were controlled by endoscopic transmural duodenocystostomy. It took 8 months to resolve the pancreatic duct injury-associated pancreatitis. The experience in this case suggests that iatrogenic pancreatic duct injury during resection of CC can induce catastrophic complications, thus special attention should be paid to prevent pancreatic duct injury.
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Affiliation(s)
- Jin Uk Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Kyu Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Howard TA, Murray IR, Amin AK, Simpson AH, Hall AC. Damage control articular surgery: Maintaining chondrocyte health and minimising iatrogenic injury. Injury 2020; 51 Suppl 2:S83-S89. [PMID: 31685207 DOI: 10.1016/j.injury.2019.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
Articular cartilage has limited intrinsic regenerative potential. The maintenance of healthy articular cartilage is essential to prevent joint degeneration and the morbidity associated with arthritis. In this review, we outline the structure and function of healthy articular cartilage. We summarise some of the recent literature outlining the influence of surgical factors on chondrocyte health. These factors include mechanical injury from instrumentation and drilling, drying, and the influence of irrigation fluids, antimicrobial solutions and local anaesthetics. We demonstrate that there is scope for improving cartilage viability at the time of surgery if simple chondroprotective measures are routinely adopted.
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Affiliation(s)
- Thomas A Howard
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK
| | - Iain R Murray
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK
| | - Anish K Amin
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK
| | - A Hamish Simpson
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 49 Little France Crescent, EH16 4SA, UK; The University of Edinburgh, UK.
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O'Connor E, Teh J, Lawrentschuk N. Robot-assisted ipsilateral ureteroureterostomy in a duplex system utilizing intraoperative flexible ureteroscopy. Urol Case Rep 2020; 31:101158. [PMID: 32280594 PMCID: PMC7139107 DOI: 10.1016/j.eucr.2020.101158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
Abstract
Iatrogenic injury to the ureter during pelvic surgery is an uncommon but well-documented complication. Accurate identification of the ureter during pelvic surgery is made far more complex in the presence of a duplex or ectopic system, an anomaly occurring in up to 2% of the population. In this article we present a technique for robot-assisted ipsilateral ureteroureterostomy for treatment of iatrogenic injury of a lower pole moiety ureter in a complete duplex system.
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Affiliation(s)
- Ellen O'Connor
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Corresponding author. Department of Urology, Austin Hospital, Level 8 Harold Stokes Building, 145 Studley Rd, Heidelberg, VIC, 3084, Australia. Ellen.O'
| | - Jiasian Teh
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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Cappell MS. Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm! World J Gastroenterol 2020; 26:984-991. [PMID: 32206008 PMCID: PMC7081007 DOI: 10.3748/wjg.v26.i9.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/04/2019] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists, such as surgeons and anesthesiologists, systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy. Yet gastroenterologists, like any individual, can rarely suffer acute-changes-in-mental-status from medical disorders, and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.
CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak, two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy. Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps, and absurdly “pressed” endoscopic steering dials to “take” endoscopic photographs; Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum, and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall. Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager. She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies (fulfilling ethical imperative of “physician, first-do-no-harm”), and go to emergency room for medical evaluation. Both endoscopists complied. In-hospital-work-up revealed toxic encephalopathy in both from: case-1-urosepsis and left-ureteral-impacted-nephrolithiasis; and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger. Endoscopists rapidly recovered with medical therapy.
CONCLUSION This rare syndrome (0.0011% of endoscopies) may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy. Recommended management (followed in both cases): 1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury; 2- inform Chief-of-Gastroenterology; and 3-immediately intervene to abort endoscopy to protect patient. Syndromic features require further study.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology & Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
- Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, United States
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Iwanaga J, Cleveland MK, Wada J, Tubbs RS. How to avoid iatrogenic lingual nerve injury in the retromolar area: an anatomical study of retromolar pad and lingual nerve. Surg Radiol Anat 2020; 42:523-8. [PMID: 31989215 DOI: 10.1007/s00276-020-02422-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between the retromolar gland and pad, and the relationship between the LN and retromolar gland/pad to establish a new landmark for avoiding LN injury. METHODS Sixty-two lingual nerves from fresh-frozen cadavers were used for this study. The age of the specimens at the time of death ranged from 57 to 98 with a mean of 76.5 years. The mucous incision was made into the medial border of the retromolar pad and the submucosal tissue depth of the initial incision was bluntly dissected to expose the lingual nerve. When the LN was identified, the mucosa overlying the retromolar pad was removed to expose the retromolar gland to confirm if the retromolar pad corresponds to the retromolar gland. RESULTS On all sides, the lingual nerve was found to course medial to the retromolar pad and inferior to the inferior border of the superior pharyngeal constrictor muscle to enter the sublingual space via the pterygomandibular space. The retromolar pad corresponded to the retromolar gland on all sides. This demonstrated that the retromolar pad is an overlying mucosa of the retromolar gland. No LN was found to travel through the retromolar gland. CONCLUSION We suggest that the retromolar pad can be used as a new landmark for avoiding iatrogenic LN injury.
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Abstract
Vaginal fistulas (VF) represent abnormal communications between the vagina and either the distal portion of the digestive system or the lower urinary tract, but lack an accepted classification and standardised terminology. Regardless of the underlying cause, these uncommon disorders result in profound physical, psychological, sexual and social distress to the patients.Since diagnosis of VF is challenging at gynaecologic examination, ano-proctoscopy and urethro-cystoscopy, imaging is crucial to confirm the fistula, to visualise its site, course and involved organ, and to characterise the underlying disease. The traditional conventional radiographic studies provided limited cross-sectional information and are nowadays largely replaced by CT and MRI studies.Aiming to provide radiologists with an increased familiarity with VF, this pictorial paper summarises their clinical features, pathogenesis and therapeutic approach, and presents the appropriate CT and MRI acquisition and interpretation techniques that vary according to the anatomic site and termination of the fistula. The current role of state-of-the art CT and MRI is presented with examples regarding both entero- (involving the colon, rectum and anus) and urinary (connecting the bladder, distal ureter or urethra) VF. The resulting combined anatomic and functional cross-sectional information is crucial to allow a correct therapeutic choice and surgical planning.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
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Su J, Zheng LJ, Liu XQ. Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases. World J Clin Cases 2019; 7:3784-3791. [PMID: 31799305 PMCID: PMC6887598 DOI: 10.12998/wjcc.v7.i22.3784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases. However, the increased frequency and number of intravitreal injections have raised concerns about their side effects. As manipulation during surgery is relatively simple, details of the procedure are easily overlooked. Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures. We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide (TA) with the hope of providing an insight into this treatment.
CASE SUMMARY Case 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye, and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye. In view of the patients’ condition and economic constraints, an intravitreal injection of TA was administered. Due to inappropriate manipulation during surgery, the lens was injured. The site of lens injury and clinical manifestations were different in the two cases. Symptomatic treatment and continuous follow-up were carried out. The therapeutic effect following phacoemulsification of the cataract was satisfactory.
CONCLUSION Well-defined surgical incision under proper anesthesia, sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event. Careful and meticulous phacoemulsification of the cataract is suggested.
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Affiliation(s)
- Jing Su
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Li-Jun Zheng
- Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China
| | - Xin-Quan Liu
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Wanken ZJ, Barnes JA, Eppolito AJ, Zwolak RM, Suckow BD. Coil embolization of an aberrant posterior tibial artery pseudoaneurysm after total knee arthroplasty. J Vasc Surg Cases Innov Tech 2019; 5:497-500. [PMID: 31763507 PMCID: PMC6859296 DOI: 10.1016/j.jvscit.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
Arterial injury is a recognized but rare complication of total knee arthroplasty. These injuries, however, can be exceptionally devastating and potentially result in limb loss. Presentation may be delayed with symptoms associated with mass effect rather than with ischemia. We describe treatment of a patient with presentation delayed 2 weeks. In addition, the patient's arterial branch pattern demonstrated aberrant anatomy with high takeoff of the posterior tibial artery. This patient was successfully treated with transcatheter coil embolization. The current treatment options and published literature are reviewed.
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Affiliation(s)
- Zachary J Wanken
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Aaron Barnes
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Anna J Eppolito
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Robert M Zwolak
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Khilchuk A, Vlasenko S, Muradyan M, Agarkov M, Abdulkarim D, Shcherbak S, Gladyshev D, Sarana A, Litvinovskii S, Kovalik V. CT-fusion-guided endovascular repair of iatrogenic common iliac artery aneurysm: A case report. Radiol Case Rep 2019; 14:1394-1400. [PMID: 31700554 PMCID: PMC6823823 DOI: 10.1016/j.radcr.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022] Open
Abstract
We present a case of a CT-fusion-guided endovascular repair of an iatrogenic common iliac artery aneurysm in a 60-year-old male with a history of robotic prostatectomy with wide lymphadenectomy. Taking into account iatrogenic nature, rapid evolvement, previous surgical intervention, and oncological history, our team, including vascular and endovascular surgeons, refused open surgery in favor of endovascular iliac repair. We coiled the ipsilateral hypogastric artery and then deployed 2 Fluency Plus stent grafts from the common iliac into the external iliac artery. All manipulations were made under CT-fusion vascular mask control, which provided precise neck positioning, a minimal contrast infusion, reduced radiation dose, and better overall control. Our results suggest that anatomically suitable isolated iliac aneurysms can be successfully and safely treated with CT-fusion-guided endovascular repair without major perioperative and mid-term complications. The case is highlighting the potential complexity of repeated surgery with previously operated patients and the necessity of surgical and endovascular team interactions, especially in case of iatrogenic vascular complications.
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Affiliation(s)
- Anton Khilchuk
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.,Endovascular and Arrhythmology Department, Russian National Research Center of Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation
| | - Sergei Vlasenko
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Musheg Muradyan
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Maksim Agarkov
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Dana Abdulkarim
- Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation
| | - Sergei Shcherbak
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Dmitrii Gladyshev
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.,General Surgery Department, City Hospital №40, Saint-Petersburg, Russian Federation
| | - Andrei Sarana
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Sergei Litvinovskii
- Department of Cardiovascular Surgery, City Hospital №40, Saint-Petersburg, Russian Federation
| | - Vladislav Kovalik
- Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation
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