China
Africa
Explore chapters and articles related to this topic
Complications of surgery for thoracic outlet syndrome
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Although the subclavian vein is not usually directly exposed during supraclavicular decompression for neurogenic TOS, it is susceptible to injury underneath the medial clavicle and where it joins the internal jugular vein. In venous TOS, an increased network of collateral veins is usually encountered throughout the supraclavicular space. Although larger collateral vessels are preserved, such as the external jugular vein, small venous collaterals should be ligated and divided to minimize intraoperative bleeding. Any localized bleeding that may occur during the course of supraclavicular decompression should be meticulously identified and controlled, so that blood does not obscure the operative field and elevate the risk of nerve injury. When intraoperative anticoagulation and direct vascular reconstruction are performed as part of treatment for venous or arterial TOS, suture line hemostasis must be assured with meticulous suture technique and topical agents.
Supraclavicular Brachial Plexus Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The landmarks are (1) the anterior scalene muscle, immediately behind the sternocleidomastoid muscle; (2) the middle scalene muscle separated from the anterior scalene by the interscalene groove; and (3) Chassaignac’s tubercle (the anterior ramus of the transverse process of the sixth cervical vertebra). The point in the interscalene groove where Chassaignac’s tubercle is palpated represents the recommended site for insertion of the needle (Figure 1.18A). The external jugular vein usually lies close to this site.
Surgical Anatomy of the Neck
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Laura Warner, Christopher Jennings, John C. Watkinson
The internal jugular vein (IJV) runs with the carotid artery and vagus nerve in the carotid sheath. The surface marking of the IJV is parallel and slightly lateral to the common carotid artery. The external jugular vein is often visible, running inferior from the angle of the mandible, crossing at the mid-point of the sternocleidomastoid muscle and extending deep to the posterior border of the clavicular head of sternocleidomastoid to meet the internal jugular and anterior jugular veins. The anterior jugular veins run para-midline, superficial to the sternohyoid and thyrohyoid muscles.
Use of a biopsy punch for end-to-side anastomosis in free-tissue transfer
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Jae-Ho Chung, Sung-Min Sohn, Hi-Jin You, Eul-Sik Yoon, Byung-Il Lee, Seung-Ha Park, Deok-Woo Kim
In free tissue transfer for head and neck reconstruction, a number of studies reported the versatility of the ETSA technique in vein anastomosis. In the head and neck region, the external jugular vein, the anterior cervical vein, and the sizable concomitant veins of arteries, such as the facial and lingual veins, are commonly used as the recipient vein. However, the lack of appropriately sized and located veins has frequently caused problems in flap surgery [7]. In these circumstances, ETSA to the internal jugular vein can solve the problems. Yamamoto et al suggest that the internal jugular vein has the broad capacity to be the recipient of two or more ETSAs, so it can be effectively used for free flap procedures in which two or more drainage veins can be included [8]. In addition, a study by Acland suggested that the voluminous blood flow in the internal jugular vein can wash away small thrombi at the anastomotic site and can decrease the incidence of thrombus formation [9]. At our institution, ETSA to the internal jugular vein is the primary option for most cases of head and neck reconstruction.
Unfavorable outcomes in microsurgery: possibilities for improvement
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Paolo Cariati, Almudena Cabello Serrano, Fernando Monsalve Iglesias, Maria Roman Ramos, Jose Fernandez Solis, Ildefonso Martinez Lara
It is important to emphasize that only 8 of the 65 (12.3%) oncological patients received RT before reconstructive surgery in our series. Specifically, five patients from Group 1 and 3 patients from Group 2 had previously been treated with ablative surgery and postoperative radiotherapy. Hence, the quality and quantity of the vessels was acceptable in most cases. In Group 1, the facial artery was used in 86.7% of cases (n = 46), followed by the cranial thyroid artery (11.3%; n = 6), and external carotid artery (1.8%; n = 1). All arterial anastomoses were end to end. Regarding the veins, the facial vein was the most used followed by the external jugular vein. We tried to use two veins whenever possible. Also, all venous anastomoses were end to end. In Group 2, the facial artery was also the artery most frequently used (77.7%; n = 14) followed by the external carotid artery (22.2%; n = 4). No arterial anastomoses were performed with the cranial thyroid artery in this group. The external carotid artery was used after an intraoperative spasm of the facial artery in two cases and in the salvage surgery of a fibula flap 12 h after primary reconstructive surgery. In only one case was the first choice. The facial vein was the one most commonly used, followed by the external jugular vein. All arterial and venous anastomoses were end-to-end also in this group.
Distension of the maxillary vein with hepatojugular reflux
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Bedside estimation of central venous pressure (CVP) was described in 1930 by Sir Thomas Lewis who observed that the top of the jugular veins was similar to the top of the fluid column in a CVP manometer. While the internal jugular vein is preferred because it lacks valves and is more in line with the right atrium, the external jugular vein can be used, particularly in cases of extremely elevated venous pressure because the top of the internal jugular vein courses intracranially and cannot be visualized. The hepatojugular reflux maneuver is performed by applying pressure of 20–30 mmHg at the mid-abdomen for 10–30 seconds. If CVP rises >4 cm throughout the maneuver, this correlates with elevated right atrial pressure. In patients with significant volume overload, distant tributaries of the external jugular vein can become distended as well (video).