Avoiding second donor site and the second set of neck vessels in a case of absent peroneal skin perforators

This report describes the procedure of a case in which the skin paddle of the free fibula flap derived its supply solely from a soleal musculocutaneous perforator originating from the posterior tibial system. In contrast, the osteo-muscular component was supplied by the peroneal vascular system. We harvested the skin paddle with its vascular supply from the posterior tibial artery separately, and the osteo-muscular fibula was harvested with its supply from peroneal vessels. In this way, we avoided violation of the second donor site for the skin paddle. In addition, we used the distal end of peroneal vessels to salvage our skin paddle instead of sacrificing another set of neck vessels for anastomosis. This technique may also be utilised in cases where the neck vessels may not be available due to previous surgeries, radiation therapy, or decision by the surgery team to not sacrifice two sets of neck vessels for anastomosis.

Time to Loss of Behavioral and Brainstem Responses of Ducks following Non-Stunned Slaughter

Non-stunned slaughter has been extensively described for other farmed species but there has been limited research on waterfowl. The study assessed 34 White Pekin ducks (Anas platyrhynchos) (study 1) in a non-stunned halal slaughterhouse in Brazil for time to loss of consciousness using various behavioral and brainstem indices (balance, cranial nerve reflexes, and muscle tension) and assessed the relationship between extent of clotting, location of neck cut, level of damage to neck vessels/tissues, and the time to onset of unconsciousness. In addition, operator practices were separately observed and neck pathology following the cut was examined in 217 carcasses after bleeding (study 2). In study 1 following the neck cut there was a wide variation between birds in the time to loss of behavioral and brainstem indices, ranging from 20 to 334 and 20 to 383 s for neck and beak tension, respectively. The median time to loss of balance following the neck cut was 166 ± 14 (22–355) seconds. There was a moderate correlation (R = 0.60 and 0.62) between distance of the neck cut and time to loss of balance and neck tension, respectively. This is the first investigation of the time to loss of consciousness following non-stunned slaughter of ducks in commercial conditions. The findings could be used to improve the welfare of ducks during non-stunned slaughter, such as recommending performance of the neck cut closer to the jaw line and ensuring appropriate waiting periods between slaughter and birds entering the scalding tanks.

Capabilities of ultrasound scanning of head and neck vessels

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Low Bifurcation of The Left Common Carotid Artery Associated With Klippel–Feil Syndrome And Severe Stenosis of The Bilateral Proximal Middle Cerebral Artery

BackgroundThe bifurcate position of the common carotid artery is protean. It is most often locating between the C3 and C5 vertebral levels.Intrathoracic bifurcation of common carotid artery is a rare anatomic finding,and an association with bilateral segmental severe stenosis of middle cerebral artery has not been reported in the past literature .we report a case of low bifurcation of the left common carotid artery associated with Klippel–Feil syndrome and severe stenosis of the bilateral proximal middle cerebral artery.Case PresentationA 47-years old woman presented with dizziness and sleep disturbance,whose computed tomography angiography image incidentally revealed an intrathoracic bifurcation of the left common carotid artery associated with bilateral segmental severe narrowing of middle cerebral artery（MCA）.The left transverse process and spinous process of C3-4 fused and posterior arch of atlas did not fuse on Volume rendered（VR） imaging. ConclusionWe should not only pay attention to the variation of the neck vessels, but also to the serious secondary changes of intracranial vessels caused by neck vessels variation. Low carotid bifurcation may cause chronic progressive stenosis /occlusion of the proximal MCA or severe ischemic stroke events .

Successful surgical repair of traumatic aortic dissection utilizing the Najuta stent graft in a patient with pre-existing situs inversus and anomalous neck vessels

We report the case of a 39-year-old man who underwent surgical repair for traumatic Stanford type B acute aortic dissection. He was involved in a traffic accident, resulting in multiple rib fractures and a sternum fracture. On investigation, he was also found to have anatomical anomalies, namely, situs inversus and abnormality in the aortic arch and neck vessels. Thoracic endovascular aortic repair was performed as it is a less invasive procedure, thus recommended in such cases. A fenestrated thoracic endovascular aortic repair using the Najuta stent graft was found to be effective in this case where the anomalous anatomy was pre-existing.

Abrupcija na polazištu zajedničke karotidne arterije bez neurološkog deficita

Objective: In this case, we present a patient who despite iatrogenic common carotid artery disruption had no neurological impairment after vascular reconstruction. Case report: During the neck dissection in a young patient a complete abruption of the common carotid artery occurred. Median sternotomy was done for proximal bleeding control. Vascular reconstruction was done using temporary carotid shunting. The patient had no neurological consequences afterward. Conclusion: The lesion of major neck vessels is one of the most severe complications during the surgery which must be dealt with as soon as possible in best way in order to avoid permanent brain damage. In situations of iatrogenic lesions of major neck arteries heparin admission, which is usually normal therapy during vascular reconstruction, is not an option due to abrupt and uncontrollable bleeding. Thus, establishing surgically proximal and distal vascular control over the bleeding artery by vessel clamping and urgent placing of temporary intraluminal carotid shunting and best medical intraoperative therapy in this critical period of surgery might be the crucial therapeutic moment for brain protection.

Neuroenergy Mapping Diagnostic Capabilities in Hypoxic Brain Lesions

Neuroenergy Mapping (NEM) is the topographic mapping of the brain’s energy metabolism by Direct Current Potentials (DCP). It allows an independent cohort of patients (18 children from 3 to 14 years old) with sharply reduced DCP in one or more areas of the cerebral cortex to be identified among children with diagnoses of ASD and other developmental disorders. Considering the experience of working with NEM and general clinical indications for children, there appeared to be a possibility of central circulatory disorders, and patients were referred for additional examinations. These included a Doppler ultrasonography of the brain and neck vessels and X-rays of the cervical spine in three projections. Results confirmed a diagnosis of dyscirculatory encephalopathy (I67.8) for 15 of the 18 patients. For 9 of these, blood circulation disorders were aggravated by identified disorders of the cervical spine. For 3 patients, the decrease in DCP was due to physiological vasospasm.

Kommerell’s diverticulum with right-sided aortic arch and anomalous origin of neck vessels: Uncommon imaging finding in neonate with cyanosis

Kommerell diverticulum is a rare developmental anomaly of aortic arch. It is most frequently seen with right-sided aortic arch and aberrant left subclavian artery or ligamentum arteriosum, which have a significant role in completing a vascular ring. However, aberrant origin of neck vessels along with it is not commonly seen. The signs and symptoms vary depending on the severity. The paediatric patients usually present early due to compression of mediastinal structures such as trachea or oesophagus.

Prevalence of brachiocephalous arteries lesions at acute aortic dissection of type A

Acute aortic dissection is a highly disabling disease, due to severe neurological deficits caused by damage to the brachiocephalous arteries. The study enrolled 92 patients, 74% of them were men and 26% women. Everybody underwent extracranial duplex scanning and/or multispiral computer tomography of neck vessels. The narrowing of the true lumen by 60% and either the occurrence of a stroke or a transient ischemic attack against the background of the involvement of brachiocephalous arteries in the process of delamination was considered to be a significant defeat. Brachiocephalic stem was the most frequently involved (52.1%). Significant lesions were more often identified in the right common carotid artery (10.8%). Higher lethality (33%) was found in the group where brachiocephalous arteries were intervened than in the group of non-operated arteries (24%) (p = 0.048). In the first group ischemic events were revealed only before and during the surgical intervention, in the second group - only in the postoperative period. Interventions on brachiocephalic arteries in acute aortic dissection are associated with higher lethality and occurrence of ischemic events. A classification taking into account pathogenetic mechanisms of acute cerebral ischemia in case of brachiocephalous artery damage has been proposed.