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Microsurgery Jan 2024
Topics: Humans; Free Tissue Flaps; Plastic Surgery Procedures; Head
PubMed: 37953651
DOI: 10.1002/micr.31132 -
Journal of Neurological Surgery. Part... Oct 2023There are some cases where a radial artery (RA) graft is needed for a high-flow extracranial to intracranial (EC-IC) bypass as the external carotid artery (ECA)...
BACKGROUND
There are some cases where a radial artery (RA) graft is needed for a high-flow extracranial to intracranial (EC-IC) bypass as the external carotid artery (ECA) cannot be utilized as a donor artery. In this report, we describe two cases of extracranial vertebral artery (VA) to middle cerebral artery (MCA) high-flow bypass using an RA graft with an artificial vessel as an alternative bypass technique.
METHODS
The patient was placed supine with a head rotation of 80 degrees. After frontotemporal craniotomy, another C: -shaped skin incision was made at the retroauricular region and the V3 portion of the VA was exposed at the suboccipital triangle. Prior to attempting the high-flow bypass, the superficial temporal artery (STA) was anastomosed to the M4 portion of the MCA as an insurance bypass. The RA graft was anastomosed to the V3 portion of the VA that traveled under the periosteum at the supra-auricular region through an artificial vessel. After RA-M2 anastomosis, an alternative EC-IC bypass, the V3-RA-M2 bypass, was achieved.
RESULTS
Postoperative angiography demonstrated successful graft patency and no perioperative complications were observed in both cases.
CONCLUSIONS
In the cases where a high-flow bypass is required, the V3 portion of the VA is a suitable alternative proximal anastomosis site when the ECA is not a candidate donor. Furthermore, an artificial vessel shows satisfactory protection against graft complications.
PubMed: 37832591
DOI: 10.1055/s-0043-1775989 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Jan 2024To create a novel chitosan antibacterial hemostatic sponge (NCAHS) and to evaluate its material and biological properties.
OBJECTIVE
To create a novel chitosan antibacterial hemostatic sponge (NCAHS) and to evaluate its material and biological properties.
METHODS
Chitosan, a polysaccharide, was used as the sponge substrate and different proportions of sodium tripolyphosphate (STPP), glycerol, and phenol sulfonyl ethylamine were added to prepare the sponges through the freeze-drying method. The whole-blood coagulation index (BCI) was used as the screening criterion to determine the optimal concentrations of chitosan and the other additives and the hemostatic sponges were prepared accordingly. Zein/calcium carbonate (Zein/CaCO) composite microspheres loaded with ciprofloxacin hydrochloride were prepared and added to the hemostatic sponges to obtain NCAHS. Scanning electron microscope was used to observe the microscopic morphology and porosity of the NCAHS. The water absorption rate, antibacterial susceptibility rate against () and (), coagulation performance, and hemocompatibility of NCAHS were examined. The coagulation performance of NCAHS was evaluated by using rabbit liver injury and rabbit auricular artery hemorrhageear models and commercial hemostatic sponge (CHS) was used as a control. The biocompatibility, including such aspects as cytotoxicity, skin irritation in animals, and acute toxicity, of the NCAHS extracts was examined by using as a reference the national standards for biological evaluation of medical devices.
RESULTS
The NCAHS prepared with 1.5% chitosan (/), 0.01% STPP (/), 0% glycerol (/), 0.15% phenol-sulfonyl-ethylamine (/), Zein and CaCO at the mixing ratio of 5∶1 (/), Zein at the final mass concentration of 2.5 g/L, and ethanol at the final concentration of 17.5% (/) were fine and homogeneous, possessing a honeycomb-like porous structure with a pore size of about 200 μm. The NCAHS thus prepared had the lowest BCI value. The water absorption ([2362.16±201.15] % vs. [1102.56±91.79]%) and coagulation performance (31.338% vs. 1.591%) of NCAHS were significantly better than those of CHS (<0.01). Tests with the auricular artery hemorrhage model ([36.00±13.42] s vs. [80.00±17.32] s) and rabbit liver bleeding model ([30.00±0] s vs. [70.00±17.32] s) showed that the hemostasis time of NCAHS was significantly shorter than that of CHS (<0.01). NCAHS had significant inhibitory ability against and . In addition, NCAHS showed good and biocompatibility.
CONCLUSION
NCAHS is a composite sponge that shows excellent antimicrobial properties, hemostatic effect, and biocompatibility. Therefore, its extensive application in clinical settings is warranted.
Topics: Animals; Rabbits; Chitosan; Hemostatics; Escherichia coli; Glycerol; Staphylococcus aureus; Zein; Hemostasis; Anti-Bacterial Agents; Hemorrhage; Water; Ethylamines; Phenols
PubMed: 38322514
DOI: 10.12182/20240160403 -
Frontiers in Veterinary Science 2023Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the...
BACKGROUND
Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the gold standard, however it is also technically challenging, requires specialised equipment and carries certain risks. For these reasons, non-invasive blood pressure measurement devices are commonly used and are expected to provide accurate and reliable results. This requirement is particularly true for rabbits, in whom peri-anaesthetic hypotension is commonly observed and in whom perioperative mortality remains disproportionally high. Several authors have compared different non-invasive devices with invasive measurements in rabbits and have reported contrasting results. However, to date no comparison between invasive measurements and the PetMAP device, that has been designed specifically for veterinary medicine, has been reported.
AIM AND HYPOTHESIS
The aim of the study was the comparison of invasive blood pressure measurement with PetMAP in rabbits. We hypothesised that PetMAP would show acceptable agreement with the invasive measurements according to the American College of Veterinary Internal Medicine guidelines.
MATERIALS AND METHODS
Sixteen client-owned rabbits presenting for various surgical interventions were included in the study. Invasive measurements were performed by cannulation of an auricular artery. The PetMAP cuff was applied distal to the elbow according to the manufacturer's guidelines. For each measurement with PetMAP, three invasive blood pressure values were recorded. The mean of the three invasive values was compared with one value measured with PetMAP.
RESULTS
Data collected from 16 rabbits were used for statistical analysis. In the clinical setting, the PetMAP device showed significant overestimation of systolic, diastolic and mean arterial pressure, which were measured in the auricular artery. In addition, the bias was not constant, implying that the device poorly predicted changes in blood pressure.
CONCLUSION
The PetMAP device did not meet any of the American College of Veterinary Internal Medicine recommendations.
PubMed: 37492435
DOI: 10.3389/fvets.2023.1141480 -
Annals of Plastic Surgery Feb 2024The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However,...
BACKGROUND
The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes. The aim of this study is to present a new design for a postauricular chondrocutaneous flap to reconstruct the 3-dimensional curve and the folded structures in full-thickness helical defects.
METHODS
Nineteen patients with full-thickness helical defects were treated with the superior pedicle chondrocutaneous flap based on the superior auricular artery. The flap was designed on the postauricular area and comprised 3 sections, namely, deepithelialized, chondrocutaneous, and cutaneous sections (proximal to distal). Levels of patient's satisfaction on the final shape and auricular symmetry, and tissue compatibility between the flap and surrounding tissues were evaluated by the patients and objective observers.
RESULTS
The overall dimensions, projections, and curved structures of the defective helix maintained a smooth and contiguous appearance without asymmetry, notching, or trap-door deformities. The color, texture, and thickness of the flaps matched well with the adjacent auricles, and there was a moderate positive correlation between patient (9.47 ± 0.51) and observer (8.68 ± 0.63) correlation scores (r = 0.7485). The vast majority of the patients were very satisfied with the surgical outcome, and there was a statistically significant improvement in patient satisfaction (mean preoperative score, 1.26 ± 0.45; mean 12-month score, 4.79 ± 0.42; P < 0.00001).
CONCLUSIONS
Reconstruction of full-thickness helical defects requires "like tissue" characteristics and 3-dimensional cartilage support to avoid depression and notch deformities. The postauricular chondrocutaneous flap based on the superior auricular artery was shown to preserve the helical curve and folded sulcus, retain the size and subunits of the auricle, and ensure a color, texture, and thickness match between the flap and the adjacent tissues.
Topics: Humans; Surgical Flaps; Plastic Surgery Procedures; Ear, External; Ear Auricle; Arteries
PubMed: 37830506
DOI: 10.1097/SAP.0000000000003677 -
Head & Neck Jun 2024Anatomic landmarks such as the tympanomastoid suture line, posterior belly of the digastric muscle, tragal pointer, and styloid process can assist the parotid surgeon in...
BACKGROUND
Anatomic landmarks such as the tympanomastoid suture line, posterior belly of the digastric muscle, tragal pointer, and styloid process can assist the parotid surgeon in identifying and preserving the facial nerve. Vascular structures such as the posterior auricular artery and its branch, the stylomastoid artery, lay in close proximity to the facial nerve and have been proposed as landmarks for the identification of the facial nerve. In this case report, we describe an anatomic variation in which the stylomastoid artery has fenestrated the main trunk of the facial nerve, dividing it in two.
METHODS
Two patients underwent parotidectomy (one for a pleomorphic adenoma, the second for a parotid cyst) through a standard anterograde approach with identification of the usual facial nerve landmarks.
RESULTS
The appearance of the main trunk of the facial nerve was unusual in both patients due to its being fenestrated by the stylomastoid artery. The stylomastoid artery was divided, and the remainder of the facial nerve dissection was performed uneventfully with subsequent resection of the parotid mass in both patients.
CONCLUSIONS
In rare instances, the stylomastoid artery can penetrate through the common trunk of the facial nerve. This is an important anatomic variant for the parotid surgeon to be aware of, as it can increase the difficulty of facial nerve dissection.
Topics: Humans; Facial Nerve; Parotid Gland; Parotid Neoplasms; Male; Female; Adenoma, Pleomorphic; Middle Aged; Anatomic Variation; Dissection; Anatomic Landmarks; Adult; Temporal Bone
PubMed: 38610123
DOI: 10.1002/hed.27775 -
The Journal of Craniofacial Surgery May 2024The morphology of the arteries of the external ear on the affected side of congenital microtia differs from normal. The present study aimed to use computed tomography...
BACKGROUND
The morphology of the arteries of the external ear on the affected side of congenital microtia differs from normal. The present study aimed to use computed tomography angiography (CTA) to describe the anatomic variations of arteries in microtia and provide theoretical guidance for the first stage of autologous auricular reconstruction by the 2-stage method.
METHODS
Ten patients with unilateral microtia from May 2021 to August 2021 were included. Computed tomography angiography and 3-dimensional reconstruction were used to analyze the supply and branches of the main arteries of the auricle. The number of the superficial temporal artery (STA) and posterior auricular artery (PAA) branches to the auricle, vessel diameter, and the presence or absence of the STA and PAA branches were documented. The skin flap and incision were designed combined with the anatomic of auricular arteries.
RESULTS
The blood supply of the auricle mainly came from the STA and PAA. The STA's preauricular branch and PAA's posterior auricular branch were absent to varying degrees, and the middle branch was more prominent. The average diameter of the STA on the healthy auricle was 3.07±0.96 mm, and the average diameter of the PAA was 1.72±0.50 mm. The average diameter of the STA on the microtia auricle was 2.65±0.42 mm, and the average diameter of the PAA was 1.53±0.67 mm. There was a statistically significant difference in the diameter of STA between the healthy auricle and the microtia auricle (P=0.006). However, there was no significant difference in the diameter of the PAA between the healthy auricle and the microtia auricle (P=0.112). The skin flap and incision were designed and combined with the preoperative CTA images, and no flap necrosis was observed in all patients.
CONCLUSION
The vascular distribution of arteries in microtia patients was clearly and accurately assessed by CTA. In our experience, the data and detailed imaging were useful in designing skin flaps and incisions during the first stage of autologous auricular reconstruction by the 2-stage method.
PubMed: 38722569
DOI: 10.1097/SCS.0000000000010202 -
Aesthetic Plastic Surgery Nov 2023There have been many reports on replantation of complete auricle amputation, but few reports on successful replantation of partial auricle amputation. The main reason is...
BACKGROUND
There have been many reports on replantation of complete auricle amputation, but few reports on successful replantation of partial auricle amputation. The main reason is that the diameter of blood vessels at the end of auricle is only 0.3 mm, and it is difficult to find suitable blood vessels, especially venous vessels. The purpose of this study was to investigate the method of revascularization after partial auricle amputation.
METHODS
Microvascular repairs were performed in an amputated segment with only identified artery vessels for anastomosis, and vein was unavailable for anastomosis. Postoperative acupuncture bloodletting and heparin compress treatments were planned.
RESULTS
Two patients with partial ear amputation were treated at our center between 2019 and 2021. All the amputated ear were replanted successfully. No blood transfusions and no infections were observed. A week later the replanted auricles were seen, blood flow established.
CONCLUSION
Microvascular repair should be considered as the best options in cases of auricular avulsion segment replantation. When no vein was available for anastomosis, only one artery repaired was feasible. Acupuncture bloodletting and heparin compress are the effective methods to treat vein congestion.
LEVEL OF EVIDENCE V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PubMed: 37957395
DOI: 10.1007/s00266-023-03737-w -
Veterinary Clinical Pathology Sep 2023Enterprise Point-of-Care (EPOC) blood analysis is used routinely in wildlife veterinary practice to monitor blood oxygenation, but the reliability of the EPOC calculated...
Reliability of the Enterprise Point-of-Care (EPOC) blood analyzer's calculated arterial oxygen-hemoglobin saturation in immobilized white rhinoceroses (Ceratotherium simum).
BACKGROUND
Enterprise Point-of-Care (EPOC) blood analysis is used routinely in wildlife veterinary practice to monitor blood oxygenation, but the reliability of the EPOC calculated arterial oxygen-hemoglobin saturation (cSaO ) has never been validated in the white rhinoceros (Ceratotherium simum), despite their susceptibility to hypoxemia during chemical immobilization.
OBJECTIVES
We aimed to evaluate the reliability of the EPOC cSaO by comparing it against arterial oxygen-hemoglobin saturation (SaO ) measured by a co-oximeter reference method in immobilized white rhinoceroses.
METHODS
Male white rhinoceroses in two studies (both n = 8) were immobilized by darting with different etorphine-based drug combinations, followed by butorphanol or saline (administered intravenously). Animals in both studies received oxygen via intranasal insufflation after 60 min. Blood samples were drawn, at predetermined time points, from a catheter inserted into the auricular artery and analyzed using the EPOC and a co-oximeter. Bland-Altman (to estimate bias and precision) and area root mean squares (ARMS) plots were used to determine the reliability of the EPOC cSaO compared with simultaneous co-oximeter SaO readings.
RESULTS
The rhinoceros were acidotic (pH of 7.3 ± 0.1 [mean ± standard deviation]), hypercapnic (PaCO of 73.7 ± 10.5 mmHg), and normothermic (body temperature of 37.4 ± 1.8°C). In total, 389 paired cSaO -SaO measurements were recorded (the cSaO ranged between 13.2% and 99.0%, and the SaO ranged between 11.8% and 99.9%). The EPOC cSaO readings were unreliable (inaccurate, imprecise, and poor ARMS) across the entire saturation range (bias -6%, precision 5%, and ARMS 8%).
CONCLUSIONS
The EPOC cSaO is unreliable and should not be used to monitor blood oxygenation in immobilized white rhinoceroses.
Topics: Male; Animals; Oxygen; Point-of-Care Systems; Reproducibility of Results; Arteries; Animals, Wild
PubMed: 37612252
DOI: 10.1111/vcp.13236 -
Veterinary Radiology & Ultrasound : the... May 2024Tumors located at the heart base are rare in dogs and cats and aortic body tumors (chemodectoma/paraganglioma), hemangiosarcoma, ectopic thyroid carcinoma, lymphoma, and...
Tumors located at the heart base are rare in dogs and cats and aortic body tumors (chemodectoma/paraganglioma), hemangiosarcoma, ectopic thyroid carcinoma, lymphoma, and other uncommon neoplasia can be found at that location. The objective of this retrospective case series was to describe the CT characteristics of canine and feline heart base tumors. CT studies of 21 dogs and four cats with histologically or cytologically confirmed heart base tumors were reviewed for size, location, shape, margination, contrast enhancement, adjacent neovascularization, invasion, mass effect, cavitary effusions, and metastasis. Neuroendocrine tumors (15 aortic body tumors, three ectopic thyroid carcinoma, and three nonspecific neuroendocrine) were more commonly observed than hemangiosarcoma (4) and were frequently located between the cranial vena cava and aortic arch (12/21; 57%) and or dorsal to the pulmonary trunk bifurcation/pulmonary arteries (10/21; 48%). Hemangiosarcoma was more commonly found cranioventral to the aortic arch and cranial to the right auricular appendage (3/4; 75%). Mediastinal and peritumoral neovascularization was associated with 16/21 (76%) neuroendocrine tumors but none of the hemangiosarcoma. Median postcontrast attenuation in Hounsfield units (HU) was higher in neuroendocrine (110 HU) than in hemangiosarcoma (51 HU). Pericardial effusion was frequently observed with hemangiosarcoma (3/4; 75%) and infrequently in neuroendocrine (3/21; 14%). In four cases (all neuroendocrine), concurrent cranial mediastinal masses were present. CT provides useful information regarding the characteristics of heart base tumors, indicating differences between the appearance of neuroendocrine tumors and hemangiosarcoma. However, no differences were found between aortic body tumors and ectopic thyroid carcinoma.
PubMed: 38706413
DOI: 10.1111/vru.13378