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Surgical Dissection (surgical + dissection)
Selected AbstractsPlace and value of the recurrent laryngeal nerve (RLN) palpatory method in preventing RLN palsy during thyroid surgeryHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2009DSci, Áron Altorjay MD Abstract Background. In recent years, certain publications have appeared confirming that intraoperative palpation of the recurrent laryngeal nerve (RLN) is a very reliable method. Method. The characteristics of the surgical anatomy of 1023 RLN have been summarized on the basis of intraoperative palpability, running down, branching variations, thickness, and laryngeal entry site. Results. Palpation was helpful in 81.4% (833/1023), proved false positive in 8.2% (84/1023), and in 10.4% (106/1023) it was of no help in the exact localization. Definitive RLN palsy was experienced in 0.78% of all cases (8/1023), while transient paresis was encountered in 1.2% (12/1023). Only a moderately strong stochastic correlation could be found between RLN palsies and those nerves which were nonpalpable and atypical, which showed the joint occurrence of being both thinner than normal and branching already before the plane of the inferior thyroid artery (Cramer's associate coefficient, C = 0.383). Conclusion. Palpation alone cannot substitute visualization and proper surgical dissection of the nerve. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source] Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetryJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 10 2007Axel Hempfing Abstract Patellofemoral complications following knee arthroplasty are a well-known problem. Patellar ischemia has been suspected to be causative for fracture, anterior knee pain, and patella component failure. The purpose of this study was to assess the influence of knee arthroplasty surgical dissection on patellar blood flow. Patellar blood flow was measured by means of intraosseous laser Doppler flowmetry (LDF) in 10 patients undergoing total knee arthroplasty by a standard medial parapatellar approach. The initial blood flow was 121.6,±,114.7 AU. The signal significantly decreased by 71% (p,=,0.0051) when the knee was flexed and lost the pulsatile signal pattern in 80%. After arthrotomy, the signal was 100.1,±,120.3 AU in extension. The lowest signal was found in flexion and eversion of the patella (mean, 18,±,10.7 AU) and all signals lost pulsatility. As compared to the initial values, completion of the soft tissue dissection did not lead to a significant change of the blood flow signal (121.3,±,104.8; p,=,0.6835). Flexion of the knee joint markedly reduced patellar perfusion. Standard medial parapatellar approach did not significantly change patellar blood flow. This study does not support the theory of postoperative patellar ischemia as a cause of anterior knee pain or patellofemoral problems. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1389,1394, 2007 [source] Cellophane banding of congenital intrahepatic portosystemic shunts in two Irish wolfhoundsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2002N. A. Connery Two three-month-old, male Irish wolfhound siblings were diagnosed with breed-typical left divisional congenital intrahepatic portosystemic shunts consistent with patent ductus venosus. The shunts were amenable to surgical dissection at a posthepatic location. Both dogs had cellophane banding for shunt attenuation. One dog was euthanased after developing post-ligation neurological dysfunction, which was refractory to treatment. The other dog survived and demonstrated shunt attenuation. Successful surgical management using cellophane banding of a patent ductus venosus has not been previously described in a large-breed dog. [source] Variability in axillary lymph node dissection for breast cancer,,JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2004Michael Schaapveld MSc Abstract Background The axillary nodal status may influence the prognosis and the choice of adjuvant treatment of individual breast cancer patients. The variation in number of reported axillary lymph nodes and its effect on the axillary nodal stage were studied and the implications are discussed. Methods Between 1994 and 1997, a total of 4,806 axillary dissections for invasive breast cancers in 4,715 patients were performed in hospitals in the North-Netherlands. The factors associated with the number of reported nodes and the relation of this number with the nodal status and the number of positive nodes were studied. Results The number of reported nodes varied significantly between pathology laboratories, the median number of nodes ranged from 9 to 15, respectively. The individual hospitals explained even more variability in the number of nodes than pathology laboratories (range in median number 8,15, P,<,0.0001). The number of reported nodes increased gradually during the study period. A decreasing trend was observed with older patient age. A higher number of reported nodes was associated with a markedly increased chance of finding tumor positive nodes, especially more than three nodes. The frequency of node positivity increased from 28% if less than six nodes to 54% if ,20 nodes were examined, the percentage of tumors with ,4 positive nodes increased from 4 to 31%. Multivariate analysis confirmed these results. Conclusions This population-based study showed a large variation in the number of reported lymph nodes between hospitals. A more extensive surgical dissection or histopathological examination of the specimen generally resulted in a higher number of positive nodes. Although the impact of misclassification on adjuvant treatment will have varied, the impact with regard to adjuvant regional radiotherapy may have been considerable. J. Surg. Oncol. 2004;87:4,12. © 2004 Wiley-Liss, Inc. [source] Comparative Histology and Vibration of the Vocal Folds: Implications for Experimental Studies in Microlaryngeal Surgery ,THE LARYNGOSCOPE, Issue 5 2000C. Gaelyn Garrett MD Abstract Objectives/Hypothesis To determine the most suitable animal model for experimental studies on vocal fold surgery and function by a histological comparison of the microflap surgical plane and laryngeal videostroboscopy (LVS) in different species of animals. A second goal was to determine how the layered vocal fold structure in humans and three different animal species affects surgical dissection within the lamina propria. Study Design Prospective laboratory. Methods Three larynges each from dogs, monkeys, and pigs were compared with three ex vivo human larynges. Microflap surgery was performed on one vocal fold from each larynx. Both the operated and nonoperated vocal folds were examined histologically using stains specific for elastin, mature collagen, and ground substance. Based on the histological results, LVS was performed on two dogs and two pigs after first performing a tracheotomy for ventilation and airflow through the glottis. Arytenoid adduction sutures were placed to facilitate vocal fold adduction. Results The distributions of the collagen and elastin fibers were found to differ among the species with concentrations varying within species. Unlike the human vocal fold, which has a higher elastin concentration in the deeper layers of the lamina propria, both the pig and the dog had a thin band of elastin concentrated just deep to the basement membrane zone in the superficial layer. Just deep to this thin band, the collagen and the elastin were less concentrated. The monkey vocal fold had a very thin mucosal layer with less elastin throughout the mucosa. The microflap dissections in each of the dog, pig, and human vocal folds were similar, being located within that portion of the superficial lamina propria where the elastin and mature collagen are less concentrated. The microflap plane in the monkey vocal fold was more deeply located near the vocalis fibers. Despite the differences in elastin concentration, the microflap plane in both the dog and the pig was found to be similar to that in humans. The dog anatomy was much more suitable for microsuspension laryngoscopy and stroboscopic examination. The dog vocal folds vibrated in a similar fashion to human vocal folds with mucosal waves and vertical phase differences, features not seen in the pig vocal folds. Conclusions Based on both the histological and stroboscopic results, the dog was believed to be a more suitable animal model for studies on vocal fold surgery, acknowledging that no animal's laryngeal anatomy is identical to that of the human. The dog LVS model presented allows for longitudinal laryngeal studies requiring repeated examinations at multiple time periods with histological correlation applied at sacrifice. [source] New method of abdominoplasty for morbidly obese patientsANZ JOURNAL OF SURGERY, Issue 6 2004Jacob Ollapallil Introduction: We report two cases of morbidly obese patients with huge infected abdominal aprons who underwent apronectomies at Alice Springs Hospital, Northern Territory, Australia. We describe a novel technique which to date has not been described in the available literature. Patients afflicted by morbid obesity with large aprons can be incapacitated by immobility as well as suffer from recurrent infections. Apronectomy in this situation can be difficult because of the heavy weight of the apron. Method: This technique involves the use of a small crane and large orthopaedic K-nails. Two K-nails were inserted into the apron and attached to a small crane. This facilitated the elevation and manipulation of the apron during surgical dissection. The abdominal tissue removed from the female and male weighed 30 kg and 64 kg, respectively. The wounds were closed primarily and drained by three large bore suction drains. Results: The female patient had a largely uneventful postoperative course with a minor wound infection that resolved with conservative treatment. The other patient required a more protracted course of antibiotics for his more severe infection. Mobility was markedly improved in both individuals. Conclusion: This novel technique can be used successfully for severely morbidly obese individuals and can significantly reduce the surgeon's and assistants' difficulty in manipulating and handling a heavy apron during dissection. [source] | ||||||||||