scholarly journals Local Infiltration of Tranexamic Acid With Local Anesthetic Reduces Intraoperative Facelift Bleeding: A Preliminary Report

2019 ◽  
Author(s):  
Rafael A Couto ◽  
Ali Charafeddine ◽  
Nicholas R Sinclair ◽  
Laxmeesh M Nayak ◽  
James E Zins
Keyword(s):  
Tranexamic Acid ◽  
Local Anesthetic ◽  
Level Of Evidence ◽  
Time Saving ◽  
Local Infiltration ◽  
Lidocaine Solution ◽  
The Face ◽  
The Mean ◽  
Time Required ◽  
The Right

Abstract Background Rebound bleeding as a result of loss of epinephrine effect is a common problem encountered during facelift surgery. Tranexamic acid (TXA) is an anti-fibrinolytic agent whose safety and efficacy in reducing bleeding are well documented. We have found that local infiltration of TXA combined with a lidocaine with epinephrine solution during facelift surgery has been effective in decreasing rebound bleeding and the time required to gain hemostasis. Objectives The authors sought to share their local infiltration protocol of TXA combined with epinephrine solution in facelift. Methods Patients who underwent facelift received subcutaneous injection of TXA-lidocaine 0.5% solution following the authors’ protocol. After completing both sides of the facelift and the submental platysmaplasty, the first and second sides were sequentially closed. The time to gain hemostasis on each side prior to closure was prospectively measured. Results Twenty-seven consecutive patients who underwent facelift surgery received local infiltration of TXA-lidocaine solution. In 23 of the 27 patients, the time required for hemostasis was prospectively recorded. The mean age was 62.1 years (±9.3) and all were females. The average time spent achieving hemostasis on the right, left, and both sides of the face was 6.5 (±2.7), 6.3 (±2.1), and 12.9 (±4.2) minutes, respectively. The total surgical time saving is approximately 25 to 60 minutes. Although primary facelift [13.6 (± 4.3)] exhibited a longer time of hemostasis compared with the secondary group [10.2 (± 2.8)], this was not statistically significant (P = 0.09). Conclusions Local infiltration of TXA with local anesthetic prior to a facelift appears to decrease bleeding, operative time, and postoperative facelift drainage output. Level of Evidence: 4

Nonsurgical Redefinition of the Chin and Jawline of Younger Adults With a Hyaluronic Acid Filler: Results Evaluated With a Grid System Approach

2020 ◽  
Author(s):  
Dario Bertossi ◽  
Massimo Robiony ◽  
Andrea Lazzarotto ◽  
Giorgio Giampaoli ◽  
Riccardo Nocini ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Grid System ◽  
Level Of Evidence ◽  
Younger Adults ◽  
Lower Face ◽  
Age Related ◽  
Tissue Edema ◽  
The Face ◽  
The Mean ◽  
And Performance

Abstract Background Aesthetic treatment of the lower face is increasingly in demand, particularly owing to age-related changes in appearance. VYC-25L is a novel hyaluronic acid filler with high G′ and high cohesivity, specifically designed for sculpting and contouring of the chin and jaw. Objectives The aim of this study was to assess the use of a grid traced onto the chin and jaw for guiding treatment with VYC-25L. Methods This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the lower third of the face with VYC-25L. A grid system of horizontal and vertical lines was used to systematize the process of treatment planning and performance. Results Thirty subjects were enrolled (53.3% female; mean [standard deviation] age, 34.4 [2.8] years). The mean quantity of VYC-25L used was 4.0 [0.8] mL. Based on the 5-point Global Aesthetic Improvement Scale, 29 patients (96.7%) rated their appearance at 20 days posttreatment as “much improved” or “very much improved.” The only complications recorded were early transient soft-tissue edema (n = 14; 46.7%) and bruising (n = 6; 20.0%). There were no cases of infection, paresthesia, asymmetry, hematoma, necrosis, or skin discoloration. Conclusions Treatment of the chin and jawline with VYC-25L, with injection locations determined by a standardized grid-based approach, appears to be effective and safe with high rates of patient satisfaction. Injection of this filler offers a potentially high-impact approach for patients across a variety of biological and economic circumstances. Level of Evidence: 4

scholarly journals Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

2021 ◽  
Vol 87 (1) ◽  
pp. 175-179
Author(s):  
Thibault Dewilde ◽  
Sebastiaan Schelfaut ◽  
Sven Bamps ◽  
Matthias Papen ◽  
Pierre Moens
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Technical Note ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Coronal Balance ◽  
Scoliotic Deformity ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

Prospective Study Assessing the Effect of Local Infiltration of Tranexamic Acid on Facelift Bleeding

2020 ◽  
Author(s):  
Andrew L Kochuba ◽  
Demetrius M Coombs ◽  
Grzegorz J Kwiecien ◽  
Nicholas R Sinclair ◽  
James E Zins
Keyword(s):  
Tranexamic Acid ◽  
Local Anesthetic ◽  
Postoperative Bleeding ◽  
Anesthetic Techniques ◽  
Level Of Evidence ◽  
Dose Time ◽  
Patient Demographics ◽  
Major Complications ◽  
Postoperative Drainage ◽  
Age Range

Abstract Background Rebound bleeding during facelift surgery is a major cause of facelift hematomas. Subcutaneous infiltration of tranexamic acid (TXA) combined with lidocaine and epinephrine was recently retrospectively shown to decrease rebound bleeding. No study has prospectively examined the effect of subcutaneous TXA on intraoperative and postoperative bleeding during facelift surgery. Objectives The aim of this study was to prospectively demonstrate that TXA combined with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage. Methods This was a prospective, single-surgeon, case-control study performed between July 2019 and March 2020. Thirty-nine patients (35 female and 4 male; mean age, 64.9 years; age range, 49-80 years) underwent facelift surgery alone or in combination with facial rejuvenation procedures. All patients were injected subcutaneously with 1 or 2 mg/mL TXA + 0.5% lidocaine/1:200,000 epinephrine. Patient demographics, TXA dose, time to hemostasis, drain output, and minor and major complications were recorded. Results The mean time to hemostasis was 6.4 minutes for the left and right sides each. Average postoperative day (POD) 0 drain outputs were 13.9 mL (left) and 10.1 mL (right). Average POD 1 drain outputs were 15.1 mL (left) and 15.6 mL (right). Drains were removed from all patients on POD 1 or 2. There were 2 minor complications (flap necrosis plus infection, marginal mandibular neuropraxia) and no major complications. Conclusions TXA safely and effectively decreased bleeding, operating room time, and drain output compared with traditional local anesthetic techniques. Our future goal is to determine if epinephrine can be completely removed from the local anesthetic and replaced with TXA for facelift surgery. Level of Evidence: 2

scholarly journals Reliability and efficiency of three methods of calculating migration percentage on radiographs for hip surveillance in children with cerebral palsy

2018 ◽  
Vol 12 (2) ◽  
pp. 145-151 ◽  
Author(s):  
V. A. Kulkarni ◽  
J. R. Davids ◽  
A. D. Boyles ◽  
N. Q. Cung ◽  
A. Bagley
Keyword(s):  
Cerebral Palsy ◽  
Absolute Difference ◽  
Measurement Tool ◽  
Digital Measurement ◽  
Level Of Evidence ◽  
Digital Templating ◽  
Children With Cerebral Palsy ◽  
Migration Percentage ◽  
The Mean ◽  
Time Required

Purpose Hip surveillance programmes for children with cerebral palsy (CP) utilize the migration percentage (MP) measurement to initiate referrals and recommend treatment. This study assesses the reliability and efficiency of three methods of MP measurement on anteroposterior (AP) pelvis radiographs. Methods A total of 20 AP pelvis radiographs (40 hips) of children with CP were measured by three raters on two occasions using three methods: digital measurement (DM) on a Picture Archiving and Communication System monitor, computer-aided measurement (CA) using a digital templating tool and mobile device application measurement (MA) using a freely available MP measurement tool. For each method, the time required to complete the MP measurement of both hips on each AP pelvis radiograph was measured. Intra-class correlation coefficient (ICC) was used to determine reliability, and analysis of variance was used to compare groups. Results All three methods of determining MP showed excellent inter-rater and intra-rater reliability (ICC 0.976 to 0.989). The mean absolute difference in MP measurement was not significant between trials for a single rater (DM 2.8%, CA 1.9%, MA 2.2%) or between raters (DM 3.6%, CA 2.9%, MA 3.6%). The mean time to complete MP measurement was significantly different between methods, with DM = 151 seconds, CA = 73 seconds and MA = 80 seconds. Conclusion All three MP measurement methods were highly reliable with clinically acceptable measurement error. The time required to measure a hip surveillance radiograph can be reduced by approximately 50% by utilizing a computer-based or mobile application-based MP measurement tool. Level of Evidence III

scholarly journals Pachyderma in Primary Cutaneous NK and T-Cell Lymphoma and Leukemia Cutis

2017 ◽  
Vol 9 (3) ◽  
pp. 151-157
Author(s):  
Eve Lebas ◽  
Cesar Chian ◽  
Nazli Nikkels-Tassoudji ◽  
Jorge E. Arrese ◽  
Arjen F. Nikkels
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Oral Steroids ◽  
The Face ◽  
Leukemia Cutis ◽  
The Mean ◽  
The Right ◽  
Atypical Manifestation

Background: Pachyderma is defined as severely thickened skin with deep folds and is occasionally observed with primary cutaneous NK and T-cell lymphoma (pCNKTCL), primary cutaneous B-cell lymphoma (pCBCL), and leukemia cutis (LC). Aim: To describe the clinical, histological, and therapeutic particularities of a series of pCNKTCL, pCBCL, and LC patients with pachyderma. Results: In a series of pCNKTCL (n = 70), pCBCL (n = 12), and LC (n = 2) patients followed up during 9 years, 6 cases of pachyderma were observed. Pachyderma occurred on the arms (n = 2), thighs (n = 1), forehead (n = 1), and face (n = 2). The mean age of the patients was 69 years (51–82). The stages were erythrodermic (T4) mycosis fungoides (MF) (n = 1), folliculotropic MF (FMF) (n = 2), classic (T2) MF (n = 2), and chronic myeloid leukemia (n = 1). The erythrodermic MF patient with acute pachyderma on the right arm responded rapidly to oral steroids. The other cases were indolent, appeared progressively, and were highly treatment resistant. Histology revealed dense dermal neoplastic infiltration. The immunohistological profile of the pachydermic lesions was similar to common MF and LC. Conclusion: Pachyderma is an atypical manifestation of MF and LC and may occur on the face (FMF) or the extremities (MF). The rapidly appearing pachyderma may be transitory and responds readily to oral steroids.

scholarly journals TOMOGRAPHIC STUDY OF THE S2-ALAR-ILIAC SCREW TECHNIQUE IN BRAZILIAN MEN

2019 ◽  
Vol 18 (3) ◽  
pp. 226-230
Author(s):  
LUIS PIMENTEL SOMBRA ◽  
RICARDO TEIXEIRA E SILVA ◽  
THIEGO PEDRO FREITAS ARAÚJO ◽  
OLAVO LETAIF BIRAGHI ◽  
RAPHAEL MARTUS MARCON ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Adult Males ◽  
Anthropometric Parameters ◽  
Level Of Evidence ◽  
Bone Length ◽  
Iliac Screws ◽  
Pulling Forces ◽  
Iliac Screw ◽  
The Mean ◽  
The Right

ABSTRACT Objective The use of pedicle screws was a milestone for modern spinal surgery. This type of fixation, due to its superior biomechanics, gave greater fixation power, greater capacity to withstand the pulling forces and, therefore, greater stability and lower rates of pseudoarthrosis. Fixation of the lumbosacral junction, even with the development of these new implants, remains a challenge mainly because the considerable rates of pseudoarthrosis. The use of iliac screws solves the biomechanical difficulties. However, its use shows high rates of surgical wound problems. The S2-Alar-Iliac screw (S2AI) came as a solution to these complications. The lack of studies about anatomical and anthropometric parameters in the Brazilian population justifies the study. Methods Eleven hip tomographies of Brazilian adult males were analyzed by four evaluators. The right and left sides were considered. In each patient, measurements were made of greater and shorter bone length, greater and smaller bone diameter, distance from the entry point to the skin, sagittal and axial angles related to the hypothetical insertion of an S2AI screw and compared to the same measurements obtained with the iliac screw. Results The mean bone length was 136.7 mm, the greatest bone diameter was 24.8 mm, the smallest bone diameter was 19.7 mm and the distance from the screw to the skin was 42.1 mm for the S2AI screw. Conclusions The obtained data present an average of the sample that can be useful in the decision of the surgical technique in the studied group. Level of evidence I; Diagnostic Studies (Anatomical Investigation).

scholarly journals DOES DECUBITUS AFFECT NEURAL ELEMENTS POSITIONING? A MRI STUDY COMPARING DORSAL AND LATERAL POSITION

2020 ◽  
Vol 19 (4) ◽  
pp. 255-257
Author(s):  
LUCAS NUNES SALES DE MELO ◽  
RAFAEL BARRETO SILVA ◽  
JOSÉ CARLOS BARBE GONÇALVES ◽  
GABRIELA AIELLO FERNANDES PANTAROTO
Keyword(s):  
Dura Mater ◽  
Lateral Position ◽  
Medial Wall ◽  
Level Of Evidence ◽  
Shortest Distance ◽  
Lateral Decubitus ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Mri Study

ABSTRACT Objective To evaluate the displacement of nerve structures according to the decubitus position of the patient in a magnetic resonance imaging (MRI) study. Methods MRI was performed at a radiology clinic in 20 patients in dorsal and right lateral decubitus. The measurement considered was the shortest distance between the dura mater and the medial wall of the pedicle. Results The largest measurement was 11.6 mm in left lateral decubitus, 12.2 mm in right lateral decubitus, 10.5 mm in right dorsal decubitus, and 9.2 mm in left dorsal decubitus. In some patients the space between the medial wall of the pedicle and the dura mater was larger when in lateral decubitus, while in others when in dorsal decubitus. The mean displacement of the measurements on the left was 1.14 mm and on the right 1.355 mm. Conclusions The structures moved on average little more than 1 mm in the positions studied. The positioning of the patient for surgery does not change the space to be approached, being the surgeon’s choice according to his learning curve. Level of evidence II; Prospective study of lower quality.

scholarly journals COMPARATIVE STUDY OF LUMBAR PLEXUS PATH ON THE LEFT AND RIGHT SIDES THROUGH THE PSOAS MUSCLE

2018 ◽  
Vol 17 (4) ◽  
pp. 262-265
Author(s):  
Emiliano Neves Vialle ◽  
Luiz Roberto Gomes Vialle ◽  
Letícia Cardoso Ern ◽  
Luis Miguel Duchén Rodríguez ◽  
Grover Coaquira Huayta ◽  
...  
Keyword(s):  
Psoas Muscle ◽  
Transverse Process ◽  
Lateral Approach ◽  
Anatomical Landmark ◽  
Wilcoxon Test ◽  
Lumbar Plexus ◽  
Level Of Evidence ◽  
Left And Right ◽  
The Mean ◽  
The Right

ABSTRACT Objective: Spine surgery with a minimally invasive lateral approach and validate possible anatomical differences between the right and left sides. Methods: Four measurements (cm) were taken on 38 cadavers: the distance between the lumbar plexus and the transverse process (L4-L5) and the distance between the lumbar plexus and the midline of the lumbar spine, both on the right and left sides. Results: The mean distance between the lumbar plexus and the transverse process of L4-L5 was 1.03 cm and the distance to the midline was 3.99 cm for the right side. The averages of the left side were 1.13 cm and 3.38 cm, respectively. There is statistical difference between the sides (p<0.05) using the non-parametric Wilcoxon test. Conclusions: The authors suggest that the transverse process might be used as an anatomical landmark to define the surgical approach through the psoas muscle. Level of Evidence IV; Cadaveric study.

scholarly journals Clinical parameters of the local anesthetic effects of bupivacaine applied with and without a vasoconstrictor in oral implantology

2007 ◽  
Vol 64 (9) ◽  
pp. 611-615 ◽  
Author(s):  
Milos Duka ◽  
Zoran Lazic ◽  
Novak Stamatovic ◽  
Zoran Tatic ◽  
Marija Bubalo ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Latent Period ◽  
Local Anesthesia ◽  
Local Anesthetic ◽  
Oral Surgery ◽  
Clinical Parameters ◽  
Local Infiltration ◽  
Dental Implantation ◽  
Retrobulbar Block ◽  
The Right

Background/Aim. Bupivacaine (Marcaine?), homologue of mepivacaine, chemically related to lidocaine, is used as a local anesthetic for local infiltration, peripheral nerve block, retrobulbar block, symphathetic block, and caudal and epidural anesthesia. The aim of this investigation was to determine and to compare clinical parameters of the local anesthetic effects of bupivacaine applied with and without a vasoconstrictor. Methods. This investigation included a total of 30 randomly selected patients, who ranged in age from 30?60 years, with partial or total anodontia in the molar region of the mandible. These patients with total or partial edentulous molar part of the mandible, scheduled for dental implantation placement, were asked to participate in the study. In the first phase of the investigation, the patients were subjected to local anesthesia with 3.5 cm3 of 0.5% bupivacaine with a vasoconstrictor (adrenalin, 1: 200 000) in the right side of the mandible. After administering local anesthesia, the placement of blade, cylindrical, transdental (B.C.T.) implants was performed. In the second stage of the investigation, in 7?10 days period after the first oral surgery, the patients were subjected to local anesthesia with 3.5 cm3 of 0.5% bupivacaine, but without a vasoconstrictor, in the left side of the mandible. After administering local anesthesia, the placement of B.C.T. implants was performed. During the performance of both oral surgery procedures, the following clinical parameters of the local anesthetic effects were monitored: latent period, duration and the potency of anesthesia, and the evaluation of the postoperative pain level. Results. The latent period under local anesthesia with 3.5 cm3 of 0.5% bupivacaine and vasoconstrictor was statistically significantly shorter than without vasoconstrictor. The duration of local anesthesia was longer without vasoconstrictor. There was no difference in the potency of anesthesia with or without a vasoconstrictor, while the lowest level of postoperative pain was found after administering bupivacaine without a vasoconstrictor use. Conclusion. The results of this investigation show that bupivacaine without a vasoconstrictor is efficient when used for local anesthesia in placing dental implants since it provides better blood circulation required for good dental implant osseointegration. .

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