The Retroauricular Incision as an Effective and Safe Alternative Incision for Decompressive Hemicraniectomy

2021 ◽  
Author(s):  
Ehsan Dowlati ◽  
Armin Mortazavi ◽  
Gregory Keating ◽  
Ribhu Tushar Jha ◽  
Daniel R Felbaum ◽  
...  
Keyword(s):  
Absolute Risk ◽  
Wound Complications ◽  
Safe Alternative ◽  
Question Mark ◽  
Decompressive Hemicraniectomy ◽  
Surface Areas ◽  
Average Surface Area ◽  
Average Defect ◽  
Surgical Site Complications ◽  
Scalp Incision

Abstract BACKGROUND The reverse question mark (RQM) incision has been traditionally utilized to perform decompressive hemicraniectomies (DHC) to relieve refractory intracranial hypertension. Alternative incisions have been proposed in the literature but have not been compared directly. OBJECTIVE To present the retroauricular (RA) incision as an alternative incision that we hypothesize will increase calvarium exposure to maximize the removal of the hemicranium and will decrease wound-related complications compared to the RQM incision. METHODS This study is a retrospective review of all DHCs performed at our institution over a span of 34 mo, stratified based on the type of scalp incision. The surface areas of the cranial defects were calculated, normalizing to their respective skull diameters. For those patients surviving beyond 1 wk, complications were examined from both cohorts. RESULTS A total of 63 patients in the RQM group and 43 patients in the RA group were included. The average surface area for the RA and RQM incisions was 117.0 and 107.8 cm2 (P = .0009), respectively. The ratio of average defect size to skull size for RA incision was 0.81 compared to 0.77 for the RQM group (P = .0163). Of those who survived beyond 1 wk, the absolute risk for surgical site complications was 14.0% and 8.3% for RQM and RA group (P = .5201), respectively. CONCLUSION The RA incision provides a safe and effective alternative incision to the traditional RQM incision used for DHC. This incision affords a potentially larger craniectomy while mitigating postoperative wound complications.

Size, shape, and surface area of beaver, Castor canadensis, a semiaquatic mammal

1993 ◽  
Vol 71 (5) ◽  
pp. 876-882 ◽  
Author(s):  
P. S. Reynolds
Keyword(s):  
Surface Area ◽  
Body Mass ◽  
Marine Mammal ◽  
Body Shape ◽  
Castor Canadensis ◽  
Total Surface Area ◽  
Energetic Efficiency ◽  
Terrestrial Mammals ◽  
Surface Areas ◽  
Average Surface Area

The beaver, Castor canadensis, is a large, herbivorous, semiaquatic rodent. Beaver forage on land as well as in water; thus functional compromise between competing activities should result in a less streamlined body shape than expected for a similarly sized marine mammal. Standard morphometrics and surface areas of 70 Wisconsin beaver ranging in size from 5 to 35 kg were measured. Geometric similarity of surface area was maintained during growth (i.e., area was proportional to body mass raised to the 2/3 power). Scaly-tail area was positively allometric with body mass; hind foot web area was weakly negatively allometric. The surface area of the unfurred extremities (hind feet and scaly tail) comprised 30% of the total surface area of adults and over 50% for younger beaver. The average surface area of 21 adult beaver (mean body mass = 20 kg) was 0.52 m2. This value was significantly lower (P < 0.001) than predicted from the Meeh equation for terrestrial mammals, but similar to that expected for a marine mammal of equivalent mass. Body shape was described by the fineness ratio (a hydrodynamic index of streamlining). The fineness ratio for beaver was 4.8, a value similar to that for phocid seals. Therefore, in spite of expected constraints on body shape imposed by herbivory and the competing demands of terrestrial and aquatic foraging, beaver do not differ significantly in overall shape from other, more aquatic, species. However, shape alone is not a reliable indicator of either hydrodynamic or energetic efficiency. Future comparative studies should incorporate both phylogeny and biomechanical data into evaluations of mammalian morphology.

scholarly journals Is Single Use Portable Incisional Negative Pressure Wound Therapy System Suitable for Revision Arthroplasty?

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Thomas Hester ◽  
Shoib Mahmood ◽  
Farid Moftah
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Revision Arthroplasty ◽  
Wound Complication ◽  
Senior Author ◽  
Wound Complications ◽  
Standard Group ◽  
Wound Therapy ◽  
Safe Alternative ◽  
Single Use

Incisional negative pressure wound therapy (INPWT) has been used for high-risk surgery across specialties but has yet to be utilised for revision hip and knee surgery. Between 2013 and 2014, patients who underwent revision arthroplasty by the senior author were identified. 36 (9 hips and 27 knees) operations in 36 patients identified 18 (8 male, median age 77 (61–86)) who received standard dressing and 18 (12 male, median age 67 (58–81)) who received single use portable INPWT dressings (4 hips, 14 knees). Wound complications were seen in 3 (2 knees) from the standard group and 1 (hip) in the INPWT group (p=0.14). There was no statistical difference in age or gender between groups. Risk factors (BMI > 30, smoking, and diabetes) were identified in 9 patients, median ASA 3, in the standard group and 10 patients, median ASA 2, in the INPWT group. There were no dressing related complications. This is the first study of INPWT with a low pressure single use 80 mmHg dressing with revision arthroplasty. This initial study showed a threefold decrease in wound complication in the INPWT group and that INPWT is a safe alternative to standard dressings.

scholarly journals Surface area analysis in edentulous jaws of patients with skeletal class I

2011 ◽  
Vol 58 (4) ◽  
pp. 209-215 ◽  
Author(s):  
Srdjan Postic
Keyword(s):  
Surface Area ◽  
Class I ◽  
Anthropometric Parameter ◽  
Average Surface ◽  
Skeletal Class ◽  
Surface Areas ◽  
Significant Difference ◽  
Average Surface Area ◽  
The Right ◽  
Edentulous Jaws

Introduction. The surface area of edentulous jaw has been considered as an important functional and anthropometric parameter. The aim of this study was to assess the surface area of supporting tissue in edentulous jaws of patients with the skeletal class I. Material and Methods. Thin aluminum foils (0.5 mm of thickness) were adapted on plaster surfaces of 139 pairs of edentulous jaws casts. Foils were positioned on a millimeter-paper in order to measure their areas. Additionally, surface areas were measured using a mechanic plan-meter (G. Coradi, Zurich, Switzerland, serial no. 49823). The measurement error was 1%. Skeletal class of edentulous jaws was determined by analysis of lateral cephalometric radiographs, and assessing the ANB (SNA, SNB) angle. Results. The average surface area of edentulous upper jaws was 4654?407 mm2 in males, and 4212?368 mm2 in females. Edentulous lower jaws had average surface area of 2843?339 mm2 in males, and 2334?295 mm2 in females. Statistically significant difference (p<0.001) was found in comparison of surface areas and dimensions of upper and lower edentulous jaws in male and female. ANB values ranged from 2 to 4 degrees. Conclusion. The surface area is an important parameter in the analysis of edentulous jaws. Edentulous jaws in males had greater surface areas and dimensions as compared to females. Edentulous areas on the right side were not absolutely symmetric to areas on the left side.

scholarly journals Investigation of Long and Short-Term Water Surface Area Changes in Coastal Ramsar Sites in Turkey with Google Earth Engine

2022 ◽  
Vol 11 (1) ◽  
pp. 46
Author(s):  
Adalet Dervisoglu
Keyword(s):  
Surface Area ◽  
Water Surface ◽  
Google Earth ◽  
Short Term ◽  
Annual Average ◽  
Surface Areas ◽  
Inland Wetlands ◽  
Increasing Trend ◽  
Average Surface Area ◽  
Term Analysis

Deltas and lagoons, which contain many flora and fauna, have rich coastal ecological and biological environments, and are wetlands of vital importance for humans. In this study, the current problems in all coastal Ramsar sites in Turkey are summarized, and changes in water surface areas are investigated using Landsat and Sentinel 1/2 satellite images on the Google Earth Engine (GEE) cloud computing platform. Landsat TM and OLI images were used in the long-term analysis, and time series were created by taking annual and July to September averages between 1985 and 2020. In the short-term analysis, monthly averages were determined using Sentinel 2 images between 2016 and 2020. Sentinel-1 Synthetic Aperture Radar (SAR) images were used in the months when optical data were not suitable for use in monthly analysis. The Normalized Difference Water Index (NDWI) was used to extract water surface areas from the optical images. Afterwards, a thresholding process was used for both optical and radar images to determine the changes. The changes were analyzed together with the meteorological data and the information obtained from the management plans and related studies in the literature. Changes in the water surface areas of all coastal Ramsar sites in Turkey were determined from 1985 to 2020 at different rates. There was a decreasing trend in the Goksu and Kızılırmak Deltas, which also have inland wetlands. The decreasing rates from 1985 to 2020 were −24.52% and −2.86%, for annual average water surfaces for the Goksu and Kızılırmak Deltas, respectively, and −21.64% and −6.34% for the dry season averages, respectively. However, Akyatan Lagoon, which also has inland wetlands, showed an increasing trend. Observing the annual average surface area from 1985 to 2020, an increase of 438 ha was seen, corresponding to 7.65%. Every year, there was an increasing trend in the Gediz Delta and Yumurtalık Lagoons, that do not have inland wetlands. The increasing rates from 1985 to 2020 were 46.01% and 17.31% for the annual average surface area, for the Gediz Delta and Yumurtalık Lagoons, respectively, and 38.34% and 21.04% for the dry season average, respectively. The obtained results reveal the importance of using remote sensing methods in formulating strategies for the sustainable management of wetlands.

scholarly journals Time to Focus on the Scalp Incision Design for Chronic Subdural Hematoma: Technical Note and Experience

2021 ◽  
Author(s):  
Juexian Xiao ◽  
Yu Liu ◽  
Shikai Gui ◽  
Feng Wei ◽  
Tong Zhou ◽  
...  
Keyword(s):  
Wound Healing ◽  
Subdural Hematoma ◽  
Medical Records ◽  
Operative Procedure ◽  
Large Angle ◽  
Chronic Subdural Hematoma ◽  
Technical Note ◽  
Question Mark ◽  
Scalp Incision

Abstract Objective: The scalp incision design in surgery for chronic subdural hematoma (CSDH) is important but is given little attention or is neglected by most neurosurgeons currently. Faulty scalp incision design will affect the ease of surgery, wound healing, and patients’ satisfaction. This study introduces the technique and experience used in our center regarding scalp incision with an adjustable question mark-shaped for CSDH procedures.Methods: A retrospective analysis was conducted of the medical records of patients with CSDH, who underwent surgical treatment that incorporated this incision design from September 2017 through December 2020. The features of concern were intraoperative scalp incision extension and postoperative wound healing. Those patients were followed for occurrences of scalp dysfunction, and their satisfaction with this design.Results: Thirty-seven patients were analyzed. For 2 patients, operative procedures were changed and scalp incisions were extended. All patients had good incision healing without complications. The outpatient or telephone follow-up 6 months after surgery revealed that 36 patients were satisfied with the scalp incision design, one patient experienced widening of incision scar. Six patients (5 women and 1 man) reported cosmetic dissatisfaction, and 7 patients (six women and one man) had mild scalp dysfunction, in daily life.Conclusion: The adjustable question mark-shaped incision used for CSDHs is a fluent curve, with a large angle, and allows a flexible extension. It ensures ease of the operative procedure, good wound healing and meeting patients’ aesthetic needs. The protocol is simple, practical, and worthy of reference by neurosurgeons, especially in primary hospitals.

scholarly journals An altered posterior question-mark incision is associated with a reduced infection rate of cranioplasty after decompressive hemicraniectomy

2020 ◽  
pp. 1-9
Author(s):  
Michael Veldeman ◽  
Lorina Daleiden ◽  
Hussam Hamou ◽  
Anke Höllig ◽  
Hans Clusmann
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Skin Flap ◽  
Cohort Analysis ◽  
Univariate Analysis ◽  
Superficial Temporal Artery ◽  
Multivariate Logistic Regression Model ◽  
Occipital Artery ◽  
Question Mark ◽  
Decompressive Hemicraniectomy

OBJECTIVEPerforming a cranioplasty (CP) after decompressive craniotomy is a straightforward neurosurgical procedure, but it remains associated with a high complication rate. Surgical site infection (SSI), aseptic bone resorption (aBR), and need for a secondary CP are the most common complications. This observational study aimed to identify modifiable risk factors to prevent CP failure.METHODSA retrospective analysis was performed of all patients who underwent CP following decompressive hemicraniectomy (DHC) between 2010 and 2018 at a single institution. Predictors of SSI, aBR, and need for allograft CP were evaluated in a univariate analysis and multivariate logistic regression model.RESULTSOne hundred eighty-six patients treated with CP after DHC were included. The diagnoses leading to a DHC were as follows: stroke (83 patients, 44.6%), traumatic brain injury (55 patients, 29.6%), subarachnoid hemorrhage (33 patients, 17.7%), and intracerebral hemorrhage (15 patients, 8.1%). Post-CP SSI occurred in 25 patients (13.4%), whereas aBR occurred in 32 cases (17.2%). An altered posterior question-mark incision, ending behind the ear, was associated with a significantly lower infection rate and CP failure, compared to the classic question-mark incision (6.3% vs 18.4%; p = 0.021). The only significant predictor of aBR was patient age, in which those developing resorption were on average 16 years younger than those without aBR (p < 0.001).CONCLUSIONSThe primary goal of this retrospective cohort analysis was to identify adjustable risk factors to prevent post-CP complications. In this analysis, a posterior question-mark incision proved beneficial regarding infection and CP failure. The authors believe that these findings are caused by the better vascularized skin flap due to preservation of the superficial temporal artery and partial preservation of the occipital artery. In this trial, the posterior question-mark incision was identified as an easily and costless adaptable technique to reduce CP failure rates.

scholarly journals Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

2019 ◽  
Vol 30 (2) ◽  
pp. 253-258 ◽  
Author(s):  
Rafael De la Garza Ramos ◽  
Jonathan Nakhla ◽  
Daniel M. Sciubba ◽  
Reza Yassari
Keyword(s):  
Infection Rate ◽  
Revision Surgery ◽  
Screw Fixation ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Mechanical Failure ◽  
Adult Patients ◽  
Wound Complications ◽  
The North ◽  
Iliac Screw

OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)—27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)—25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)—18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

scholarly journals How I do it—the posterior question mark incision for decompressive hemicraniectomy

2021 ◽  
Vol 163 (5) ◽  
pp. 1447-1450
Author(s):  
Michael Veldeman ◽  
Mathias Geiger ◽  
Hans Clusmann
Keyword(s):  
Complication Rate ◽  
Question Mark ◽  
Decompressive Hemicraniectomy ◽  
Skull Reconstruction ◽  
Number Of Patients ◽  
Lower Complication ◽  
Lower Complication Rate

Abstract Background Decompressive hemicraniectomy (DHC) is a lifesaving procedure which every neurosurgeon should master early on. As indications for the procedure are growing, the number of patients eventually requiring skull reconstruction via cranioplasty also increases. The posterior question mark incision is a straightforward alternative to the classic trauma-flap and can easily be adopted. Some particularities exist one should consider beforehand and are discussed here in detail. Methods Surgical steps, aids, and pitfalls are comprehensively discussed to prepare surgeons who wish to gain experience with this type of incision. Conclusion Due to the lower complication rate after cranioplasty, the posterior question mark incision has superseded the traditional pre-auricular starting anterior question mark incisions, in our department for the performance of decompressive hemicraniectomies.

Sodium-pump density of cells from dog tracheal mucosa

1985 ◽  
Vol 248 (5) ◽  
pp. C389-C398 ◽  
Author(s):  
J. H. Widdicombe ◽  
C. B. Basbaum ◽  
E. Highland
Keyword(s):  
Surface Area ◽  
Sodium Pump ◽  
Apical Membrane ◽  
Cell Types ◽  
Total Surface Area ◽  
Basal Cells ◽  
Tracheal Mucosa ◽  
Average Surface ◽  
Surface Areas ◽  
Average Surface Area

Uptake of tritiated ouabain by cells isolated from dog tracheal epithelium showed two components: a saturable component with a Km of 5.1 X 10(-8) M and a maximal uptake of 8.3 X 10(5) molecules/cell and a nonsaturating component of uptake that was linear with concentration. Several criteria indicated that the saturable uptake component represented binding to the Na+-K+-ATPase. To estimate the average surface area per cell, a known number of cells were pelleted and weighed, and the average surface area was calculated, assuming the cells to be perfectly spherical. The validity of this assumption was confirmed by comparing the calculated surface areas of cells in isotonic and hypotonic media. From the values for maximal saturable uptake and average surface area, a pump density of approximately 2,400 sites/micron2 was calculated. Given that the apical membrane lacks Na pumps and accounts for only approximately 5% of the total surface area, this value corresponds to the pump density of the basolateral cell membrane. The pump densities of ciliated, goblet, and basal cells were compared by autoradiography. The three cell types had approximately the same density of pump sites.

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