Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

2018 ◽  
Vol 35 (02) ◽  
pp. 108-116 ◽  
Author(s):  
Lucas Ritschl ◽  
Rali Georg ◽  
Andreas Kolk ◽  
Marco Kesting ◽  
Klaus-Dietrich Wolff ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Area Under The Curve ◽  
Perfusion Index ◽  
Segment Length ◽  
Mandible Reconstruction ◽  
Distal Fibula ◽  
Fibula Graft ◽  
Time To Peak ◽  
Perfusion Studies ◽  
Free Fibula

Background Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion. Methods All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study. ICG videoangiography of cancellous bone perfusion was performed using a handheld ICG camera. Videos were analyzed, and a perfusion curve was generated. Peak enhancement, time to peak, slope, and wash-in area under the curve were extracted; rise time, wash-in rate (WiR), and wash-in perfusion index were calculated. Results were statistically analyzed with regard to distal fibula segment length and number of osteotomy sites. Results Thirty-nine patients (age 59 ± 8 years) were included in the study. Mandible reconstruction was achieved with 1 (n = 15), 2 (n = 13), or 3 (n = 11) fibula segments. The WiR was 6.4 ± 2.3 and 4.4 ± 0.2 before and after proximal osteotomy, respectively. The wash-in perfusion index was 114.2 ± 48.4 before and 84.4 ± 20.0 after proximal osteotomy. Bone perfusion was significantly reduced after additional proximal osteotomies. Both the segment length and number of proximal osteotomies correlated with bone perfusion, with longer segments and fewer osteotomies showing higher perfusion. Conclusion This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.

scholarly journals Characterization of the thrombin generation profile in systemic lupus erythematosus

2017 ◽  
Vol 104 (1) ◽  
pp. 35-41 ◽  
Author(s):  
A Kern ◽  
E Barabás ◽  
A Balog ◽  
Sz Burcsár ◽  
M Kiszelák ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Thrombin Generation ◽  
Area Under The Curve ◽  
Autoimmune Disorder ◽  
Systemic Lupus ◽  
Time To Peak ◽  
Cat Assay ◽  
Coagulation Tests ◽  
Healthy Control

Systemic lupus erythematosus (SLE) is a multisystemic inflammatory autoimmune disorder. Thrombotic events occur at a higher incidence among SLE patients. The investigation of thrombin generation (TG) with calibrated automated thrombogram (CAT) test as a global hemostasis assay is applicable for the overall functional assessment of the hemostasis. The aim of this study was to characterize the hemostatic alterations observed in SLE by CAT assay. In this study, CAT parameters and basic coagulation parameters of SLE patients (n = 22) and healthy control subjects (n = 34) were compared. CAT area under the curve (i.e., endogenous thrombin potential) was lower than normal in SLE (807 vs. 1,159 nM*min, respectively), whereas other CAT parameters (peak, lag time, time to peak, and velocity index) and the basic coagulation tests were within the normal range. The presence of anti-phospholipid antibodies and the applied therapy was not associated with hemostasis parameters in SLE. We concluded that the reported high risk of thrombosis is not related to TG potential.

scholarly journals Nutrient content changes from steaming or soaking timothy-alfalfa hay: effects on feed preferences and acute glycemic response in Standardbred racehorses1

2019 ◽  
Vol 97 (10) ◽  
pp. 4199-4207
Author(s):  
Tiana G Owens ◽  
Madeline Barnes ◽  
Vanessa M Gargano ◽  
Louise Julien ◽  
Wilfredo D Mansilla ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Area Under The Curve ◽  
Nutrient Content ◽  
Dust Particles ◽  
Glycemic Response ◽  
Nutrient Losses ◽  
Time To Peak ◽  
Alfalfa Hay ◽  
Average Blood Glucose ◽  
Standardbred Racehorses

Abstract Soaking hay and steaming hay are strategies that are used to reduce respirable dust particles for horses but may result in variable nutrient losses, including nonstructural carbohydrates (NSC) and minerals. Since these losses have not been quantified in Canadian hay yet, the first aim of this study was to identify nutrient losses from first-cut timothy-alfalfa hay grown in southern Ontario, Canada, after soaking for 30 min or steaming for 60 min. It is uncertain whether horses prefer hay when it is dry, soaked, or steamed. To address this, 13 Standardbred racehorses were offered 2 of these hays side by side for 30 min on 6 consecutive occasions until all possible combinations had been offered. Quantity of hay eaten was determined and horses were video recorded during feedings to assess time spent eating and investigating hay. Additionally, consumption of feeds with differing NSC levels has been observed to influence glycemic response in horses; however, this has not been measured in horses consuming steamed hay before and the results from soaked hay studies have been inconclusive. As such, the final aim of this study was to examine acute glycemic response in horses after being fed dry, soaked, and steamed hays. Blood glucose was measured every 30 min from 9 Standardbred racehorses for 6 h following a meal of 0.5% of their body weight of treatment hay on a dry matter basis (DMB). Soaked, but not steamed, hay had lower concentrations of soluble protein, NSC, and potassium in contrast to the same dry hay (P < 0.05). Peak glucose, average blood glucose, total area under the curve, and time to peak did not differ among treatments (P > 0.05). We conclude that acute glycemic response of racehorses was not influenced by soaking or steaming hay. Horses also consumed less soaked hay (DMB) than dry or steamed hay (P < 0.05) and spent less time eating soaked hay than dry or steamed hay (P < 0.05).

One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia

2018 ◽  
Vol 12 (4) ◽  
pp. 330-335
Author(s):  
Hazibullah Waizy ◽  
Hans Polzer ◽  
Nils Schikora ◽  
Andreas Forth ◽  
Felix Becker ◽  
...  
Keyword(s):  
Bone Graft ◽  
Plantar Flexion ◽  
Treatment Options ◽  
Skin Incision ◽  
Metatarsal Bone ◽  
Distal Fibula ◽  
Fibula Graft ◽  
Patient Reported ◽  
Standing Up ◽  
Pain Symptoms

Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.

scholarly journals Long-Term Changes in Bone Height After Mandibular Reconstruction Using a Free Fibula Graft in an Elderly Population

2017 ◽  
Vol 75 (12) ◽  
pp. 2682-2688 ◽  
Author(s):  
Kosuke Ishikawa ◽  
Yuhei Yamamoto ◽  
Hiroshi Furukawa ◽  
Yoichi Ohiro ◽  
Akira Satoh ◽  
...  
Keyword(s):  
Elderly Population ◽  
Mandibular Reconstruction ◽  
Fibula Graft ◽  
Long Term Changes ◽  
Free Fibula ◽  
Bone Height ◽  
Free Fibula Graft

Is Perfusion MRI without Deconvolution Reliable for Mismatch Detection in Acute Stroke? Validation with 15O-Positron Emission Tomography

2018 ◽  
Vol 46 (1-2) ◽  
pp. 16-23 ◽  
Author(s):  
Johanna Reimer ◽  
Cornelia Montag ◽  
Alexander Schuster ◽  
Walter Moeller-Hartmann ◽  
Jan Sobesky ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
At Risk ◽  
Acute Stroke ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Treatment Decisions ◽  
Emission Tomography ◽  
Time To Peak ◽  
Positron Emission ◽  
First Moment

Background: In acute stroke, the magnetic resonance (MR) imaging-based mismatch concept is used to select patients with tissue at risk of infarction for reperfusion therapies. There is however a controversy if non-deconvolved or deconvolved perfusion weighted (PW) parameter maps perform better in tissue at risk prediction and which parameters and thresholds should be used to guide treatment decisions. Methods: In a group of 22 acute stroke patients with consecutive MR and quantitative positron emission tomography (PET) imaging, non-deconvolved parameters were validated with the gold standard for penumbral-flow (PF) detection 15O-water PET. Performance of PW parameters was assessed by a receiver operating characteristic curve analysis to identify the accuracy of each PWI map to detect the ­upper PF threshold as defined by PET cerebral blood flow <20 mL/100 g/min. Results: Among normalized non-deconvolved parameters, PW-first moment without delay correction (FM without DC) > 3.6 s (area under the curve [AUC] = 0.89, interquartile range [IQR] 0.85–0.94), PW-maximum of the concentration curve (Cmax) < 0.66 (AUC = 0.92, IQR 0.84–0.96) and PW-time to peak (TTP) > 4.0 s (AUC = 0.92, IQR 0.87–0.94) perform significantly better than other non-deconvolved parameters to detect the PF threshold as defined by PET. Conclusions: Non-deconvolved parameters FM without DC, Cmax and TTP are an observer-independent alternative to established deconvolved parameters (e.g., Tmax) to guide treatment decisions in acute stroke.

scholarly journals Correlation of Perfusion Index Change and Analgesic Efficacy in Transforaminal Block for Lumbosacral Radicular Pain

2019 ◽  
Vol 8 (1) ◽  
pp. 51 ◽  
Author(s):  
Jin Young Lee ◽  
Eung Don Kim ◽  
Yoo Na Kim ◽  
Ji Seob Kim ◽  
Woo Seog Sim ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Analgesic Efficacy ◽  
Epidural Injection ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Perfusion Index ◽  
Objective Method ◽  
Peripheral Perfusion ◽  
Index Change ◽  
Transforaminal Epidural Injection

Transforaminal epidural injection is used to treat radicular pain. However, there is no objective method of assessing pain relief following transforaminal injection. Perfusion index is a metric for monitoring peripheral perfusion status. This study evaluates the correlation between perfusion index change and analgesic efficacy in transforaminal blocks for lumbosacral radicular pain. We retrospectively analyzed data of 100 patients receiving transforaminal block for lumbosacral radicular pain. We assessed perfusion index before treatment and at 5, 15, and 30 min following the block. We defined responders (group R) and non-responders (group N) as those with ≥50% and <50% pain reduction, respectively, 30 min following block. Clinical data and perfusion index of the groups were analyzed. Ninety-two patients were examined, of whom 57 (61.9%) and 35 (38.0%) patients reported ≥50% and <50% pain reduction, respectively. Group R had a significantly higher perfusion index change ratio 5 min following the block (p = 0.029). A perfusion index change ratio of ≥0.27 was observed in group R (sensitivity, 75.4%; specificity, 51.4%; AUC (area under the curve), 0.636; p = 0.032). A perfusion index change ratio of ≥0.27 at 5 min after block is associated with, but does not predict improvement in, pain levels following lumbosacral transforaminal block.

scholarly journals Retrospective analysis and clinical evaluation of mandible reconstruction with free fibula flap

2006 ◽  
Vol 29 (6) ◽  
pp. 285-291 ◽  
Author(s):  
V. Wedler ◽  
M. Farshad ◽  
M. Sen ◽  
C. Koehler ◽  
A. Hanschin ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Clinical Evaluation ◽  
Free Fibula Flap ◽  
Mandible Reconstruction ◽  
Fibula Flap ◽  
Free Fibula
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