scholarly journals COMPLICATIONS OF ARTHROSCOPIC DRILLING IN THE TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE IN CHILDREN AND ADOLESCENTS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0009
Author(s):  
Soroush Baghdadi ◽  
David Isaacs ◽  
Calvin Chan ◽  
Lawrence Wells ◽  
Theodore J Ganley ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Retrospective Chart Review ◽  
Loose Body ◽  
Activity Level ◽  
Minimal Risk ◽  
Safe Procedure ◽  
Time Of Surgery ◽  
Initial Surgery ◽  
Gender Status

Background: Arthroscopic drilling is a well-established treatment for stable intact OCDs of the knee in children when non-operative treatment fails. The decision to proceed to operative treatment requires a discussion regarding the risks and benefits of surgical intervention. While there is abundant data suggesting that OCD drilling is a highly effective treatment strategy, there is little data specifically evaluating the risks and complications of this procedure. Purpose: The goal of this study was to assess the complications of drilling of stable OCDs of the knee, and the risk factors for developing complications. Methods: In a retrospective chart review from 2009-2017, data from patients <18 years old who underwent arthroscopic drilling for stable intact OCD lesions of knee were collected. Lesions treated with other techniques (fixation, chondroplasty, OATS), and those with <3 months of follow-up were excluded. Characteristics of the lesions, treatment approach, and post-operative course were recorded. For bilateral surgeries, each knee was considered a separate record. Results: 139 knees in 131 patients were evaluated, of which 102 (73%) were male. The mean age was 12.7years. 108 knees (77%) had an open physis at the time of operation. Patients were managed conservatively for a mean of 6.76 months pre-operatively (SD=6.6). Average follow-up was 14.8 months after the initial surgery (SD=13.25). 53 patients (38%) were obese or overweight at the time of surgery. All patients regained full ROM within 5° of the contralateral knee at a mean 12.9 weeks post-op (SD=3.2), with all but 7 (5 %) returning to activities of daily living at the 3-month visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. 6 knees (4.3%) underwent 7 additional surgeries during the follow-up period, all of which were for treatment failure in non-healing lesions (loose body removals, chondroplasty, or repeat drilling). In a multiple logistic regression model, age, gender, status of the physis at the time of surgery, BMI percentile, and OCD size were not predictive of the need for additional surgeries. Discussion: Our findings suggest that arthroscopic drilling for OCDs of the knee is a safe procedure with minimal risk of complications. The majority of patients return to their pre-operative daily activity level with full ROM by 3 months after surgery. Complications, including reoperation, were related to the progression of the OCD, rather than the surgical procedure.

scholarly journals Short Term Radiographic and Patient Outcomes of a Novel Biplanar Plating System for Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Kshitij Manchanda ◽  
Stephen Blake Wallace ◽  
Junho Ahn ◽  
George T. Liu ◽  
Michael D. Van Pelt ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Time Of Surgery ◽  
Radiographic Parameters ◽  
Valgus Angle ◽  
Patient Reported ◽  
Outcome Scores

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus is a complex deformity of the great toe and is a major cause of pain for patients. Despite the variety of techniques, traditional osteotomies often do not address rotational deformities. A novel biplanar plating system was used to perform correction of metatarsal rotation at our institution starting in 2017. The purpose of this study was to determine the correction of rotational deformity and of radiographic parameters, maintenance of this correction (versus recurrence of hallux valgus), complication rates and patient-reported objective survey scores. We sought to determine prognostic factors for successful correction, including age, gender, and time of surgery. Methods: By retrospective chart review, we identified all patients treated by the novel biplanar plating at our institution. We recorded patient demographics, pre-operative range of motion and maltracking, surgical details, operative complications, and any subsequent surgery. Imaging was reviewed at pre-operative and post-operative visits to approximate the hallux valgus angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP). Outcome scores (AOFAS, FAAM, SF12 PCS and MCS) pre- operatively and post-operatively at 3 months, 6 months and 12 months were also recorded. The changes in these radiographic parameters and scores were then computed and analyzed to determine if there was an improvement with surgery. Results: Fifty-seven procedures (in 55 patients) were performed and evaluated. There were 8 complications and average follow- up time was 27.1 weeks (+13.8 weeks). Older age was significantly associated with more complications (p = 0.018). Gender and time of surgery did not show any significant association with complications. Radiographic parameters including HVA, IMA, and TSP were analyzed. At 3 and 6 months post-operatively, these parameters were significantly reduced from pre-operative values. At 12 months, there was a trend towards significant reduction (p values of 0.06, 0.06, and 0.053 respectively); however, there were fewer patients who maintained follow-up during this period. The Outcome scores showed improvement post-operatively, but only the AOFAS score showed statistical significance at 3 and 6 months. Conclusion: Although statistical analysis was limited due to our population size and the retrospective nature of the study, there was an overall improvement in both radiographic parameters and clinical outcome scores. Older patients are also at higher risk of complications. Malrotation correction with this biplanar plating system is a novel technique and does require meticulous training. With continued expansion of our patient database and further longitudinal analysis, we hope to determine not only if correction is maintained over time, but also if the steepness of the learning curve affects the number of complications earlier versus later in each individual surgeon’s experience.

scholarly journals BMI INCREASES AFTER ACL-RECONSTRUCTION IN ADOLESCENTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0017
Author(s):  
Regina Hanstein ◽  
Noah Kirschner ◽  
Christine Moloney ◽  
Eric Fornari
Keyword(s):  
Quality Of Life ◽  
Acl Reconstruction ◽  
Patient Population ◽  
Activity Level ◽  
Self Report ◽  
Adolescent Patient ◽  
Post Surgery ◽  
Initial Surgery

Background: The incidence of ACL injuries in the pediatric and adolescent patient population has increased over the last 20 years. ACL reconstruction is recommended to avoid osteoarthritis later in life. However, a 6-12 months rehabilitation with no or limited sports activity after surgery is required to protect the graft and graft fixation. The aim of this study was to determine, if this period of inactivity affects the BMI in an adolescent patient population and affects patient self-reported outcomes. Methods: A retrospective review of 115 patients between the ages of 12 and 21 years, who had undergone ACL reconstruction with hamstring or bone-patellar-bone autograft by a single orthopaedic surgeon between 2013 and 2017 was performed. 44 patients had records of height and weight pre- and post-operatively (6 months, 1 year, at most recent follow-up: average 2.09 years, range 1-5.25 years). BMI was calculated using the CDC BMI calculator for child & teen or adult, depending on the age of the patient. Based on this, patients were categorized as having a normal weight, being overweight or obese. Patient self-report outcomes - PediIKDC, Tegner-Lysholm and KOOSChild - were reviewed. Data was analyzed using Student’s t-test and Spearman correlation. Results: BMI did not change in the 6 months after ACL reconstruction, but was significantly higher 1 year after ACL reconstruction and at most recent follow-up compared to BMI at initial surgery (Table 1). Sub-analysis by gender revealed that males had a higher BMI at both timepoints, whereas females only showed an increase in BMI at most recent follow-up, but not at 1 year post-surgery. While 26.1% of male patients were obese at surgery, 54.2% were obese 6 months after ACL reconstruction and 40.9% at 1 year (Figure1). At most recent follow-up, the distribution of patients in the weight categories was similar to that at initial surgery. This trend was not seen in female patients. A selection-bias for overweight and obese patients in the follow-up period can be ruled out, as obesity or overweight were not related to complications after surgery. BMI weakly correlated with better outcomes for the KOOSChild Quality of Life domain at 6 months after surgery (r=0.450, p=0.031) and trended to be weakly correlated with the KOOSChild Symptom domain (p=0.071), KOOSChild Sport domain (p=0.076) and PediIKDC (p=0.061). No correlation between BMI and patient outcomes was found at 1 year after ACL reconstruction or at most recent follow-up. Conclusion: After ACL-reconstruction, adolescents gain weight, most likely due to limited activity during the rehabilitation phase. This weight gain was more pronounced in males than females. The increase in BMI lasted longer than the period of rehabilitation-related inactivity. Patients with higher BMI rated their Quality of Life better at 6 months. The activity restrictions might not have affected these patients usual life style, however, data on activity level before ACL injury was not available. [Table: see text][Figure: see text]

scholarly journals Efficacy of botulinum toxin for treating cramps in peripheral neuropathy

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Tejas Mehta ◽  
Richard Sommers ◽  
Raghav Govindarajan
Keyword(s):  
Botulinum Toxin ◽  
Peripheral Neuropathy ◽  
Pain Score ◽  
Chart Review ◽  
Botulinum Toxin A ◽  
Retrospective Chart Review ◽  
Wilcoxon Test ◽  
Safe Procedure

Abstract Introduction: Muscle cramps are a common occurrence in patients with peripheral neuropathy and are known to cause significant distress and decrease the quality of life. Although several drug formulations have been used in the management of cramps, there is significant variability in terms of efficacy and tolerability in patients with peripheral neuropathy. This study aims to assess the efficacy of botulinum toxin A in the management of lower limb cramps in patients with peripheral neuropathy.   Methods: This retrospective chart review included a total of ten patients with peripheral neuropathy with cramps. Relevant data such as age, gender, race, pain score and cause of peripheral neuropathy were documented. Statistical analyses to compare the variables was done using the Wilcoxon Test. The pain score before the administration, at 3-month, 6 month and 9 months follow up were compared.   Results All patients enrolled in the study showed improvement of pain assessed by visual pain analog scale. An improvement of 1.60 (95%CI, p<0.05), 2.70 (95%CI, p<0.05) and 3.50 (95%CI, p=0.05) was noted between test scores from before administration of botulinum toxin to 3-month, 6 months and 9 months follow up with a range of 6, 4 and 4 respectively.   Conclusion: Local BTX-A infiltration is a likely efficacious and safe procedure for improving pain associated with cramps in patients with peripheral neuropathy.

S244 – Intraoperative ABR after Myringotomy and Tube Placement

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P157-P157
Author(s):  
Nanette Sturgill ◽  
Joshua G Yorgason ◽  
Albert H Park
Keyword(s):  
Middle Ear ◽  
Chart Review ◽  
Medical Center ◽  
Hearing Threshold ◽  
Retrospective Chart Review ◽  
Tube Placement ◽  
Threshold Levels ◽  
Time Of Surgery ◽  
The Difference

Objectives Understand the utility of intraoperative ABR testing after myringotomy and tube placement. Methods We performed a retrospective chart review of 27 patients (mean age 23 months) who underwent intraoperative ABR (ioABR) after myringotomy and tube placement at Primary Childrens Medical Center from 2004 to 2007. Paired t-tests were perfomed to analyze the difference in threshold levels from the ioABR to follow up behavioral audiometry at 1kHz and 4kHz frequencies, accounting for the presence or absence of fluid at the time of surgery. Results 15 patients (29 ears) showed a mean improvement of 10 dB at the 1 kHz frequency (p=0.007), and 16 patients (31 ears) improved by 5 dB at 4kHz (p=0.83). An improvement of at least 15 dB was seen in 45% of patients (13/29 ears) at 1 kHz and in 26% (8/31 ears) at 4 kHz; 5 patients improved by as much as 35–50 dB. Of the patients whose thresholds improved by at least 15 dB, 77% at 1 kHz and 83% at 4 kHz showed evidence of fluid at the time of the ioABR Conclusions Patients who undergo ioABR testing show a significant improvement of dB level on follow-up behavioral audiometry. Many patients whose hearing threshold improved by at least 15 dB had fluid at the time of myringotomy. Therefore, the presence of middle ear pathology may lead to an overestimation of ioABR thresholds. Consequently, ioABR results should be interpreted with caution in isolation, and subsequent audiometric testing should always be performed to validate prior results.

scholarly journals Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

2016 ◽  
Vol 125 (1) ◽  
pp. 102-110 ◽  
Author(s):  
Abhiram V. Gande ◽  
Srinivas Chivukula ◽  
John J. Moossy ◽  
William Rothfus ◽  
Vikas Agarwal ◽  
...  
Keyword(s):  
Pain Relief ◽  
Dorsal Root ◽  
Retrospective Chart Review ◽  
Activity Level ◽  
Occipital Neuralgia ◽  
Nerve Blocks ◽  
Repeat Surgery ◽  
Ct Guided

OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed. Fifty-five patients were included because they met the International Headache Society's (IHS) diagnostic criteria for ON, responded to CT-guided nerve blocks at the C-2 dorsal nerve root, and had at least one follow-up visit. Telephone interviews were additionally used to obtain data on patient satisfaction. RESULTS Forty-two patients (76%) were female, and the average age at surgery was 46 years (range 16–80). Average follow up was 67 months (range 5–150). Etiologies of ON included the following: idiopathic (44%), posttraumatic (27%), postsurgical (22%), post–cerebrovascular accident (4%), postherpetic (2%), and postviral (2%). At last follow-up, 35 patients (64%) reported full pain relief, 11 (20%) partial relief, and 7 (16%) no pain relief. The extent of pain relief after CDR was not significantly associated with ON etiology (p = 0.43). Of 37 patients whose satisfaction-related data were obtained, 25 (68%) reported willingness to undergo repeat surgery for similar pain relief, while 11 (30%) reported no such willingness; a single patient (2%) did not answer this question. Twenty-one individuals (57%) reported that their activity level/functional state improved after surgery, 5 (13%) reported a decline, and 11 (30%) reported no difference. The most common acute postoperative complications were infections in 9% (n = 5) and CSF leaks in 5% (n = 3); chronic complications included neck pain/stiffness in 16% (n = 9) and upper-extremity symptoms in 5% (n = 3) such as trapezius weakness, shoulder pain, and arm paresthesias. CONCLUSIONS Cervical dorsal root rhizotomy provides an efficacious means for pain relief in patients with medically refractory ON. In the appropriately selected patient, it may lead to optimal outcomes with a relatively low risk of complications.

Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery

2020 ◽  
pp. 1-10
Author(s):  
Yoji Ogura ◽  
Jeffrey L. Gum ◽  
Alex Soroceanu ◽  
Alan H. Daniels ◽  
Breton Line ◽  
...  
Keyword(s):  
Decision Making ◽  
Blood Transfusion ◽  
Shared Decision Making ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Activity Level ◽  
Shared Decision ◽  
Initial Surgery ◽  
The Mean

OBJECTIVEThe shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery.METHODSFrom a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval.RESULTSOf 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows:1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%.2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level.3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance.4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively.5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication.6. Will I need another surgery? 25.0% will have a reoperation within 2 years.7. Will I regret having surgery? 6.5% would not choose the same treatment.8. Will I get a blood transfusion? 73.7% require a blood transfusion.9. How long will I stay in the hospital? You need to stay 8.1 days on average.10. Will I have to go to the ICU? 76.0% will have to go to the ICU.11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively.12. Will I be taller after surgery? You will be 1.1 cm taller on average.CONCLUSIONSThe above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.

scholarly journals Botulinum toxin for the treatment of lower limb cramp pain in patients with Amyotrophic Lateral Sclerosis

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Tejas Mehta ◽  
Richard Sommers ◽  
Raghav Govindarajan
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Pain Score ◽  
Lower Limb ◽  
Rating Scale ◽  
Retrospective Chart Review ◽  
Pain Scale ◽  
Wilcoxon Test ◽  
Safe Procedure ◽  
Lateral Sclerosis

Background: Muscle cramps and pain associated with them can be seen in patients with amyotrophic lateral sclerosis (ALS) and are known to reduce the quality of life. Pharmacological treatment may not benefit all patients in treating these cramps. We assess the efficacy of Onabotulinum toxin A (BTX-A) in the treatment of lower limb cramps in patients with ALS. Methods: This retrospective chart review included a total of ten patients with ALS who suffered from pain due to lower limb cramps and were managed with BTX-A. Data including patient demographics, visual analog pain scale at different intervals during follow up, ALS functional rating scale and site of onset of ALS symptoms were documented. The pain score at baseline (before administration), at 3 months follow up and at 6 months follow up were compared using Wilcoxon test to assess BTX-A’s efficacy. Results: A significant improvement in average pain score due to cramps from baseline to the 6-month interval with a change of 3.1±0.7 (p<0.05,95%CI) was seen on the pain scale. No adverse events were noted during administration or post injections. Conclusion: Local BTX-A administration is an efficacious and safe procedure for improving pain associated with cramps in patients with ALS.

scholarly journals Return-To-Sport at 5-Year Follow-Up after Non-Operative Treatment of Acute Achilles Tendon Rupture

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Fabian Krause ◽  
Andreas Schwinghammer ◽  
Till Lerch ◽  
Timo Schmid ◽  
Timo Ecker ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Operative Treatment ◽  
Tendon Rupture ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Return To Sport ◽  
Activity Level ◽  
Sports Activity ◽  
Activity Group

Category: Sports Introduction/Purpose: There is a controversy if non-operative or operative treatment for acute Achilles tendon rupture is superior. It is unknown, if young and active patients with acute Achilles tendon rupture, return to previous sports activity level after treatment with standardized non-operative immediate full weight-bearing protocol. The purpose of this was to assess (1) the return-to-sport rate and subjective satisfaction in patients with different activity levels before the rupture, at 1-year, and at 5-year follow-up, (2) the clinical outcome at 1-year follow-up, and (3) re-ruptures and complications. Methods: Out of 171 consecutive patients that were treated nonoperatively, 114 patients were available for 1-year follow-up. Eighty-nine patients responded to questionnaires for sports activity. Non-operative treatment consisted of a combination of an equinus cast and rehabilitation boot, that enables immediate full weight-bearing and early functional rehabilitation. Clinical 1-year follow-up and follow-up with questionnaires at 1-year and 5-year follow-up were evaluated to calculate Tegner Activity Scale (TAS), and Activity Rating Scale (ARS) and were compared to the status before the rupture. Based on the TAS before the rupture, patients were divided into a low-level activity (<5) and high-level activity (>5) group and the return-to-sport rate was compared between those two groups.Clinical assessment at minimum 1-year follow-up included testing of plantarflexion strength and endurance, calf circumference, and subjective parameters to calculate a modified Thermann score. Mean clinical follow-up was 34 ± 23 months (range 12-88 months). Results: (1) A significantly higher proportion (91%) of the patients in the low-level activity group returned to their previous TA at 5-year follow-up compared to patients (67%) in the high-level activity group (p=0.029). A higher proportion (91%) of the patients in the low-level activity group returned to their previous ARS Score at 5-year follow-up compared to patients (82%) in the high- level activity group (p=0,115). (2) The mean Thermann score was not significantly different between the two activity groups at minimum 1-year follow-up: 84 ±12 (range, 41-100) and 82 ±12 (range, 44 -100). (3) There were a total of 17 complications. There were 9,6% reruptures (8 with and 3 without an adequate trauma), 5 deep venous thromboses, 1 complex regional pain syndrome at 1 year follow-up. Conclusion: After 17 years of prospective evaluation, our non-operative treatment protocol for acute rupture of the Achilles tendon leads to good functional outcome, high patient satisfaction and high return-to-sport rate. Most patients return to their previous sports activity level after a standardized nonoperative early full-weightbearing treatment protocol for acute Achilles tendon rupture. Even for patients with a high activity level return to pre-rupture sports level activity was possible in two third of the patients. The re-rupture rate with immediate weight bearing is low and comparable to other non-operative treatment methods.

S255 – Treatment of Complicated and Uncomplicated Preauricular Pits

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P160-P160
Author(s):  
Richard J. Vivero ◽  
Soham Roy
Keyword(s):  
Surgical Technique ◽  
Surgical Complication ◽  
Tertiary Care ◽  
Treatment Algorithm ◽  
Recurrent Infection ◽  
Retrospective Chart Review ◽  
Surgical Excision ◽  
University Hospital ◽  
Minimal Risk

Objectives 1) To review our experience with complicated and uncomplicated preauricular pits requiring surgical excision. 2) To review relevant embryology, anatomy, and surgical technique. Methods A retrospective chart review from 2002 to 2007 was conducted at a tertiary care university hospital to identify patients less than 18 years old undergoing surgical excision of a preauricular pit. Charts were reviewed for patient age, presentation, complications, treatment algorithm, and outcome. Results 13 patients underwent surgical excision of a preauricular pit. The indication for excision was either recurrent infection or recurrent drainage in all cases. 3 of 13 patients had a pre-surgical complication of the infection, including localized cellulitis of the preauricular skin or infection of the helical cartilage. These patients were treated with a prolonged course of antibiotics prior to surgical excision. All 13 patients were treated with wide surgical excision; in the 3 patients with pre-excision complications, careful attention was paid to meticulous surgical excision of all involved tissue. There were no postoperative complications. No recurrences were noted at up to 3-year follow-up. Parents were satisfied with the cosmetic outcome in all cases. Conclusions Preauricular pits are an important entity due to their potential for significant infectious morbidity. Appropriate diagnosis and management with wide local excision, especially in the context of a complicated presentation, can result in excellent cosmesis with minimal risk of recurrence. Relevant embryology, anatomy, and surgical technique will be reviewed.

scholarly journals Extended Periarterial Sympathectomy: Evaluation of Long-term Outcomes

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 395-402 ◽  
Author(s):  
Collier S. Pace ◽  
Wyndell H. Merritt
Keyword(s):  
Vein Graft ◽  
Sympathetic Innervation ◽  
Retrospective Chart Review ◽  
High Rate ◽  
Safe Procedure ◽  
Ischemic Pain ◽  
Phone Survey ◽  
Survey Results

Background: Periarterial sympathectomy is a proposed surgical treatment for patients with refractory Raynaud syndrome; however, there is debate regarding the indications and extent of dissection. Due to the segmental arterial sympathetic innervation, we favor an extended sympathectomy in concert with vein graft reconstruction of occluded vessels when necessary. The purpose of this study is to examine outcomes of extended periarterial sympathectomy in our patients. Methods: A retrospective chart review was performed on 46 patients who underwent 58 periarterial sympathectomies (12 bilateral) since 1981. The data collected include demographics, comorbidities, previous therapy, operative details, and surgical outcomes. In addition, we contacted available patients for a phone survey. Results: Of 58 cases, 68.9% were female, 29.3% were current smokers, and 58.6% had known connective tissue disease. Thirty-three vein graft reconstructions were performed with a long-term patency of 77.4%. Sustained improvement of ischemic pain was reported in 94.8% of cases, and 78% of patients with ulcers completely healed. For the most symptomatic fingertip, mean Semmes-Weinstein monofilament measurements improved from 4.15 preoperatively to 3.29 postoperatively ( P ≤ .05). Mean follow-up was 3.97 years. Of 10 patients contacted by telephone, all reported a decrease in frequency and severity of Raynaud attacks, while 9 reported a long-term decrease in pain an average of 11.6 years after surgery. Conclusions: Extended periarterial sympathectomy is an effective and safe procedure for patients with refractory Raynaud syndrome. Our data demonstrate long-term improvement in ischemic pain and sensibility, along with a high rate of ulcer healing and patient satisfaction.

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