Pre-emptive stellate ganglion block increases the patency of radial artery grafts in coronary artery bypass surgery

Background:  We evaluated the role of pre-emptive stellate ganglion block (SGB) in preventing radial artery spasm and increasing radial artery graft patency in patients undergoing off-pump coronary artery bypass surgery.
Methods:  In this prospective randomized study, 100 patients were divided into two equal groups ( n = 50). In group A, SGB was achieved using 10 ml of ropivacaine and, in group B, SGB was not performed. Radial artery blood flow was measured pre- and intra-operatively. Post-operative clinical determinants (S–T segment elevation, use of inotropic agents, incidence of atrial fibrillation) were recorded. Early coronary angiography was performed.
Results:  According to blood flowmeter measurements, the radial artery blood flow was significantly increased in patients with SGB. The incidence of atrial fibrillation, the need for inotropic agents and S–T segment elevation were all decreased in the SGB group. Angiographic intervention revealed that the incidence of graft spasm was also lower in the SGB group.
Conclusion:  Pre-emptive SGB is an effective method for increasing radial artery blood flow and preventing radial artery spasm. Complications related to radial artery spasm may be decreased and patients may have a more comfortable post-operative period with this method.     

吻合血管的游离腓骨移植修复桡骨远端骨缺损重建腕关节8例报告

目的 :评价吻合血管的游离腓骨移植重建骨巨细胞瘤切除后桡骨远端的可行性和疗效。方法 :将带血管的腓骨近端用 2或 3枚螺钉固定于大块切除瘤体后的桡骨远端 ,腓动脉两端与切断的桡动脉远近两端吻合 ,腓静脉与皮静脉吻合。膝关节外侧副韧带和股二头肌腱固定于胫骨的适当位置。结果 :平均骨愈合时间 3 .5个月。 5例术后 1周桡动脉造影 ,证实吻合的腓动脉血流通畅。末发现患侧前臂有残留性疼痛及腕关节不稳。腕关节外形基本正常 ,主动运动良好 ,患侧手的握力均比较满意。结论 :本方法是目前治疗桡骨远端骨缺损、重建腕关节较理想的方法     

带血管蒂骨膜移植治疗腕舟骨近端骨不连

目的：评价带血管蒂骨膜瓣移植治疗腕舟骨折端骨不连的疗效。方法：以带桡动脉茎突返支桡骨骨膜移植治疗22例腕舟骨折端骨不连。通过平均13个月的随访，观察骨折愈合和腕关节功能改善情况。结果：骨折愈合20例，愈合率90．9％。腕关节功能评价：优11例，良6例，可3例，差2例，优良率77．3％。结论：该术式疗效较好，操作简单，副损伤小，是治疗腕舟骨近端骨不连的有效方法之一。     

桡动脉掌浅支腕横纹皮瓣在手指创面修复中的应用

目的:总结桡动脉掌浅支腕横纹皮瓣在手指创面修复中的应用方法及疗效。方法:2012年11月~2013年5月,收治9例手指创面患者,其中男5例,女4例;年龄13~68岁,平均42.5岁。致伤原因:机器挤压伤4例,压砸伤4例,热压伤1例。致伤部位:均为手指,其中拇指1例,示指4例,中指3例,环指1例,小指2例,指掌侧创面5例,指背侧创面4例,创面范围1.5cm×3cm~3.0cm×7cm,单纯皮肤软组织缺损1例,其余均伴指骨骨折、肌腱损伤、血管神经等损伤,急诊一期手术5例,延迟手术4例;然后采用大小为2.0cm×3.5cm~3.5cm×7.5cm的桡动脉掌浅支腕横纹皮瓣游离移植修复缺损;供区直接缝合。结果:术后皮瓣完全成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合。术后患者均获随访,随访时间6~12个月,平均8.5月。皮瓣不臃肿,颜色及质地与周围正常皮肤相似,手指外形满意。手指恢复部分浅感觉,术后6月,按中华医学会手外科学会上肢部分功能评定试用标准中拇、手指再造功能评定试用标准评定,获优7例,良1例,中1例,差0例,优良率88.89%。结论:桡动脉掌浅支腕横纹游离皮瓣具有术后功能、外观良好的优点,是修复手指创面的理想方法之一。     

Dorsal rotation flap for centralization in radial longitudinal deficiency

PURPOSE: The purpose of this report is to present the results of a dorsal rotation flap for centralization in the treatment of radial longitudinal deficiency. METHODS: All patients surgically treated for radial longitudinal deficiency with a centralization procedure and use of the dorsal rotation flap between 1996 and 2006 were retrospectively reviewed. RESULTS: Twenty-one limbs in 15 patients treated with centralization using the dorsal rotation flap were reviewed, with photographs of the scar available for review for 15 limbs in 10 patients. There were no primary wound-healing problems, no hypertrophic scarring, and no color mismatch. In the 15 limbs with available photographs, all scars were rated as good. Use of this incision allowed good surgical access to the necessary structures on the radial and ulnar side of the wrist to allow for centralization. CONCLUSIONS: The dorsal rotation flap allows rotation of the skin in a radial direction while the hand and carpus are rotated in an ulnar direction; the redundant skin on the ulnar side of the wrist is rotated to compensate for the shortage of skin on the radial side of the wrist. This report describes use of the dorsal rotation flap with no complications attributable to the surgical approach.     

Partial arthrodesis of the wrist: An investigation in cadavers

Partial arthrodesis of the wrist was performed on six cadavers in order to study the residual excursion of the wrist. Arthrodesis between the radius and scaphoid left 40 per cent extension/flexion and 61 per cent radial/ulnar deviation. Arthrodesis between the radius, scaphoid and lunate left 36 per cent extension/flexion and 59 per cent radial/ulnar deviation. Arthrodesis between the capitate, scaphoid and lunate left 59 per cent extension/flexion and 91 per cent radial/ulnar deviation.     

Use of routine histologic evaluation of carpal ganglions

PURPOSE: Although histologic evaluation is performed routinely on tissue removed during the excision of carpal ganglions, the necessity of this evaluation is uncertain. We evaluated the use of routine histologic evaluation of excised carpal ganglions and performed a cost-benefit analysis. METHODS: A retrospective review identified 160 consecutive carpal ganglion (102 dorsal, 58 volar) excisions performed over the past 7 years by 2 surgeons. The preoperative evaluation, surgical findings, and results of the pathologic assessment were evaluated for patients treated with a typical carpal ganglion excision. RESULTS: In 156 of 160 patients the preoperative and intraoperative data were highly suggestive of a carpal ganglion; the pathology reports confirmed the diagnosis in all of these patients. No new information was provided by pathologic assessment. In 4 patients the preoperative and intraoperative assessments were less certain; the pathologic assessments in these patients also were equivocal. No malignancy or condition requiring additional treatment was identified. At our institution the total cost of pathologic evaluation for a carpal ganglion including processing and interpretation fees is $352. CONCLUSIONS: Routine histologic examination of excised dorsal and volar carpal ganglions may be unnecessary if the preoperative and intraoperative evaluations are consistent with a diagnosis of carpal ganglion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Extrafascially harvested radial artery in CABG: technique of harvest, complications, and mid-term angiographic patency

BACKGROUND: The initial use of radial artery (RA) for myocardial revascularization was abandoned due to high incidence of early occlusion. The revival of radial artery graft use was attributable to the improved harvesting techniques as well as the introduction of antispasm prophylaxis by calcium channel blockers. Various techniques of harvesting RA have been described and extrafascial harvest is one of the techniques to minimize trauma during harvest. The immediate arm complications and mid-term angiographic patency of the radial artery grafts harvested using extrafascial no-touch technique and used as a conduit for myocardial revascularization were not documented well in the literature. METHODS: Between January 1997 and February 2003, 385 patients were operated for coronary artery bypass grafting using radial artery graft as one of the conduits. We used extrafascial no-touch technique and a coagulation current cautery at a strength of 10 to 15 W to control the bleeding during the blunt dissection of the radial artery. The complications related to the radial artery harvest were prospectively recorded and analyzed. This conduit was used as a free graft in 272 patients, left internal mammary artery and radial artery Y graft in 61 patients, Right internal mammary artery, and radial artery composite in situ graft in 52 patients. The radial artery donor arm in these patients was evaluated for complications. Angiographic evaluation of the radial artery graft was carried out randomly in 51 patients and angiography was done after an interval of 6 to 72 months (mean 29.55 +/- 21.77 months). RESULTS: In two patients, although the preoperative Allen test was negative, the radial artery was not harvested after completion of the dissection and was left in situ because the pulse could not be felt in the radial artery distal to the clamp after trial occlusion of the mid part of RA. The arm complications noticed were cutaneous parasthesias in 9 patients (2.33%), which subsided in 4 weeks, stitch abscess and superficial wound infection in 4 patients (1.03%), hematoma/seroma treated with drainage in outpatient department in 3 patients (0.78%), and wound infection requiring open drainage in an operating room in one patient (0.76%). Angiographically radial artery was patent in 48 of 51 patients (94.11%). CONCLUSIONS: The extrafascial technique of radial artery harvest is safe and an easily reproducible method with minimal arm complications and good mid-term clinical and angiographic results. The mid-term angiographic patency rates of RA harvested using this technique are comparable to that of the published results of intrafascially harvested radial artery grafts and left internal mammary artery grafts.     

The snuffbox technique: a reliable color Doppler method to assess hand circulation

OBJECTIVE: Although the Allen test is crude and subjective, an objective color Doppler method has yet to be established in the assessment of hand circulation before radial artery harvesting. Doppler studies so far have neglected the Doppler principle that the insonation angles should be less than 30 degrees and have not been compared with any standard except the crude Allen test. We therefore introduced the snuffbox technique, measuring the radial artery at the anatomic snuffbox, which is the most distal area after harvesting. Color Doppler methods were compared with the stump pressure as a criterion standard. METHODS: Maximal flow velocity and Doppler angles of the snuffbox, palmar artery, and ulnar artery were measured in 20 hands before and after radial artery harvesting. Stump pressure was measured during surgery. RESULTS: Maximal flow velocity in the snuffbox decreased with radial artery compression and after radial artery harvesting. All the flow patterns in the snuffbox technique showed simultaneous reversal. Maximal flow velocity in the ulnar artery increased with radial artery compression and after radial artery harvesting. Maximal flow velocity in the palmar artery did not change significantly with radial artery compression or after radial artery harvesting. Doppler angles were 20.9 degrees +/- 6.0 degrees in the radial artery of the snuffbox, 82.5 degrees +/- 6.1 degrees at the palmar artery, and 81.0 degrees +/- 7.6 degrees at the ulnar artery. The changes in the snuffbox technique were highly correlated with the stump pressure ratio (P <.001). CONCLUSIONS: Among various color Doppler methods, the snuffbox technique was precise and reliable.     

A rare variant of the radial artery: clinical considerations in raising a radial forearm flap.

A rare vascular anomaly of the radial artery encountered during elevation of a radial forearm free flap is reported in this paper. We discovered a superficial radial artery which bifurcated from the deep radial artery 4 cm below the antecubital fossa. The blood supply to the proximal radial forearm flap was thought to be from the superficial radial artery, and to the distal forearm flap from both arteries. Ascertaining the course of the radial artery pre- and intraoperatively and careful dissection of the artery are essential to minimise problems of flap transfer.