Current Practices in the Management of Postoperative Arterial Vasospasm in Microsurgery

2017 ◽  
Vol 34 (04) ◽  
pp. 242-249 ◽  
Author(s):  
Sergey Turin ◽  
Robert Walton ◽  
Gregory Dumanian ◽  
John Hijjawi ◽  
John LoGiudice ◽  
...  
Keyword(s):  
Lower Limb ◽  
Management Strategies ◽  
Superior Thyroid Artery ◽  
Recipient Vessel ◽  
Root Cause ◽  
Body Of Knowledge ◽  
Epigastric Artery ◽  
Arterial Vasospasm ◽  
Reconstructive Microsurgery ◽  
American Society

Background Postoperative microvascular arterial vasospasm is a rare clinical entity. There are no published management algorithms and also the pathophysiology of this phenomenon has not been elucidated. Methods An email survey of American Society for Reconstructive Microsurgery (ASRM) and World Society for Reconstructive Microsurgery (WSRM) members regarding their experiences with postoperative arterial vasospasm was conducted, returning 116 responses. A comprehensive literature search was conducted regarding the current body of knowledge on this entity. Results Sixty-five percent of respondents encountered cases where postoperative arterial vasospasm was clearly the cause of flap ischemia. The majority (62%) of surgeons believed a damaged segment of the artery was responsible for the spasm, with technical issues cited as the most likely cause. Sixty-two percent and 50% of surgeons used segmental resection of the recipient and donor vessels, respectively.Rated for proclivity to vasospasm, superficial inferior epigastric artery (SIEA) was the flap, superior thyroid artery (STA) the recipient vessel, and the lower limb the anatomic region most frequently mentioned.Most widely used management strategies were: topical vasodilators (91%), adventitial stripping (82%), and dilation of recipient and donor vessels (76%). Over 50% of surgeons used some type of vessel resection technique. Conclusions When flap ischemia is encountered without mechanical issues or thrombus, vasospasm can be the root cause. Certain vessels (SIEA, STA) and anatomic regions (lower limb) pose a higher risk for this phenomenon. When a vessel is affected, it is common practice to excise the questionable segment and use a graft as needed. Vessel resection as part of a multimodal approach can result in a reasonable salvage rate.

Abstract to Publication in Microsurgery: What Are the Discrepancies?

2020 ◽  
Vol 36 (08) ◽  
pp. 577-582
Author(s):  
Rose S. Maisner ◽  
Haripriya S. Ayyala ◽  
Richard L. Agag
Keyword(s):  
Conversion Rate ◽  
Statistical Significance ◽  
Reconstructive Microsurgery ◽  
The Mean ◽  
American Society ◽  
New Research ◽  
Mean Time ◽  
Comprehensive Literature Search ◽  
Abstract Presentation ◽  
Manuscript Publication

Abstract Background The American Society for Reconstructive Microsurgery (ASRM) annual meeting is a forum to present new research abstracts prior to peer-reviewed publication. The aim of this study is to determine the conversion rate, discrepancies, and time between presentation and publication. Methods A comprehensive literature search was conducted cross-referencing ASRM abstracts presented between 2014 and 2018 with peer-reviewed manuscripts. The title and authors of the abstract and manuscript, the journal of manuscript publication, and time in months between presentation and publication were recorded. The conversion rate was calculated as the proportion of publications to abstracts. Major discrepancies were defined as changes in the purpose, study design, methods, sample size, statistical analysis, results, or conclusions. Minor discrepancies were defined as changes in the title or authorship. Results Out of 667 oral abstract presentations, 361 (54%) resulted in publication. Of these abstracts, 53 were presented after their corresponding manuscripts were published. The mean conversion rate was 55.52 ± 10.17%. The mean time from presentation to publication was 13.83 months. Minor discrepancies were more frequent than major discrepancies (91 vs. 76%). The most common major and minor discrepancies involved changes in the results (63%) and authorship (79%), respectively. There was a significant association between the year of abstract presentation and whether the conclusion was changed (p = 0.001), but interyear relationships with all other discrepancies failed to reach statistical significance. Conclusion Only around half of abstracts presented at the annual ASRM conference have reached full publication in peer-reviewed journals, and most are undergoing significant changes between presentation and publication. This may be due to panel discussions at meetings suggesting study modifications, as well as revisions after careful peer review. Altering surgical practices may not be recommended based on abstracts' content.

scholarly journals What happens to our amputees? The Darling Downs experience

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095847
Author(s):  
Varun Vasudeva ◽  
Adam Parr ◽  
Alan Loch ◽  
Chris Wall
Keyword(s):  
Lower Limb ◽  
Treatment Options ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Mortality Data ◽  
Minor Amputation ◽  
Poor Outcomes ◽  
American Society ◽  
End Stage

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

scholarly journals Multi- and univariate analyses of the weekend effect for elective lower-limb joint replacements

2018 ◽  
Vol 100 (1) ◽  
pp. 42-46 ◽  
Author(s):  
WTE Briggs ◽  
BLT Guevel ◽  
AW McCaskie ◽  
SM McDonnell
Keyword(s):  
Length Of Stay ◽  
Joint Replacement ◽  
Lower Limb ◽  
Weekend Effect ◽  
Joint Replacements ◽  
Risk Patients ◽  
Postoperative Length ◽  
Day Of The Week ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction The weekend effect is a perceived difference in outcome between medical care provided at the weekend when compared to that of a weekday. Clearly multifactorial, this effect remains incompletely understood and variable in different clinical contexts. In this study we analyse factors relevant to the weekend effect in elective lower-limb joint replacement at a large NHS multispecialty academic healthcare centre. Materials and Methods We reviewed the electronic medical records of 352 consecutive patients who received an elective primary hip or knee arthroplasty. Patient, clinical and time-related variables were extracted from the records. The data were anonymised, then processed using a combination of uni- and multivariate statistics. Results There is a significant association between the selected weekend effect outcome measure (postoperative length of stay) and patient age, American Society of Anesthesiologists classification, time to first postoperative physiotherapy and time to postoperative radiography but not day of the week of operation. Discussion We were not able to demonstrate a weekend effect in elective lower-limb joint replacement at our institution nor identify a factor that would require additional weekend clinical medical staffing. Rather, resource priorities would seem to include measures to optimise at-risk patients preoperatively and measures to reduce time to physiotherapy and radiography postoperatively. Conclusions Our findings imply that postoperative length of stay could be minimised by strategies relating to patient selection and access to postoperative services. We have also identified a powerful statistical methodology that could be applied to other service evaluations in different clinical contexts.

Diabetes Management and Its Association with Transtibial Amputation

2015 ◽  
Vol 105 (3) ◽  
pp. 238-243
Author(s):  
Kun Yan ◽  
Terri K. Pogoda
Keyword(s):  
Lower Limb ◽  
Hemoglobin A1c ◽  
Diabetes Management ◽  
Management Strategies ◽  
Limb Amputation ◽  
Department Of Veterans Affairs ◽  
Related Services ◽  
Related Data ◽  
Oral Agents ◽  
Partial Amputation

Background Transtibial (TTA) and transfemoral (TFA) amputations are rarely considered as distinct events when examining major lower-limb amputation outcomes. The objective of this study was to investigate the relationships among type 2 diabetes, diabetes management strategies, hemoglobin A1c levels, and other health factors related to TTA and TFA. Methods The retrospective medical record review included abstracting demographic and health-related data from the electronic medical records of 92 patients who received amputation-related services in a Department of Veterans Affairs hospital. Results Patients who controlled their diabetes with insulin (with or without other oral agents) were significantly more likely to undergo TTA (adjusted odds ratio [aOR] = 7.63; 95% confidence interval [CI], 1.17–49.97; P = .03) compared with patients who controlled their diabetes through noninsulin medications or by diet. Patients who underwent no previous surgery (aOR = 6.66; 95% CI, 0.89-49.72; P = .06) or partial amputation only (aOR = 15.44; 95% CI, 1.04–228.29; P = .05) compared with a combination of partial amputation and bypass, thrombolectomy, or stent procedures were marginally to statistically significantly more likely to undergo TTA than TFA. Conclusions The preferential association between TTA with insulin-dependent diabetes and higher hemoglobin A1c levels versus TFA with previous lower-limb bypasses, stent placement, and thrombolytic interventions distinguishes TTA and TFA as two distinct entities, and awareness of this difference may help clinicians design preventive strategies accordingly.

scholarly journals The Effects of Wetland Droughts on a Reserve in the African Continent

2021 ◽  
pp. 22-30
Author(s):  
Lawan Bulama ◽  
Ejeh Udeh Lawrence ◽  
Ahmad Abubakar Umar
Keyword(s):  
Migratory Birds ◽  
Management Strategies ◽  
Standardized Precipitation Index ◽  
Annual Rainfall ◽  
African Continent ◽  
Body Of Knowledge ◽  
High Magnitude ◽  
Wetland Water ◽  
Drying Up ◽  
Wintering Area

Climate change and its attendant fallouts such as drought, flood etc affect every aspects of environment including wetland ecosystem. This paper seeks to examine the effects of droughts on Dagona Waterfowl Sanctuary−an important wintering area for migratory birds in Bade local government, Yobe state, Nigeria. The study used annual rainfall data collected from the archives of the Nigerian Meteorological Agency (NIMET) with respect to Nguru weather station in the area for a period of 1956-2015. Standardized Precipitation Index (SPI) in conjunction with Percentage Deviation Below Mean (PDBM) models were applied for comprehensive drought detection on a time scale of twelve (12) months. SPI anomaly graphs were plotted to depict drought of varying magnitude. The researcher went round the sanctuary and made observations with the help of binocular and telescope. Findings explicitly revealed that the study area was replete with droughts of varying intensities ranging from mild, moderate, severe and extreme ones. And high magnitude droughts led to hydrological changes causing drying up of wetland water, decreased production of seeds that provide forage opportunities, intrusion of invasive species such as typha grasses forming dense biomass that hinder birds to prey on fishes or swim freely. The result of the analysis would add to the mainstream theoretical body of knowledge about droughts effects on wetlands. The research concludes that droughts of high magnitude occurred variably and affected both native and migratory birds in the study area and hence recommend the integration of disasters like drought in the management strategies of the wetlands.

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