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Surgery of the Foot
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Yaser Ghani, Simon Clint, Nicholas Cullen
The dorsal prominence is resected with a saw or osteotome and satisfactory dorsiflexion (ideally 60°) is confirmed. Any prominent osteophytes are removed from the dorsal phalanx and the medial and lateral aspect of the head, and the joint is irrigated to thoroughly wash out. Bone wax can be used sparingly to reduce bleeding and adhesions. Moberg osteotomy – proximal phalanx osteotomy. Once cheilectomy is carried out, the range of movement should then be assessed. If the cheilectomy fails to achieve between 30° and 40° of motion, then one can consider a proximal phalanx osteotomy. This is a dorsal closing wedge osteotomy popularized by Moberg in the adult population.
Management of penetrating extracranial carotid and vertebral artery trauma
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
V2 injuries can be difficult to ligate because of their interosseous location. A standard incision is made along the anterior border of the SCM. The carotid sheath is retracted laterally. The middle thyroid vein is divided to allow access to the prevertebral space. Bone wax can be pushed firmly into the bleeding interspace between the transverse processes for control. Further direct exposure of the interosseous vertebral artery is not necessary because the space between the transverse processes can be palpated. Metal clip appliers can be guided along a probing index finger to the vertebral artery segments above and below the injured vessel under the longus colli muscle. Metal clips are placed above and below the site of injury within the same interspace, or one interspace above and below if necessary. The cervical nerve roots exit the spinal cord posterior to the vertebral artery. To avoid inadvertent nerve root injury during clipping, the clips should be applied from an anterior approach, just below the transverse process.15
Reconstructive surgery – Harvesting, skin mucosa, bone, cartilage
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Supplementary fixation is not normally needed. Prior to closure, an epidural catheter should be placed beneath the muscle so a perfusion of long-acting local anaesthetic can be established for the first 24 hours for pain relief (Figure 19.28). The use of suction drains is controversial. If the drain is placed on the cut bone surface it seems to keep draining blood for days. If the periosteum and muscle are tightly approximated, this seems to reduce the haematoma by tamponade action. Bone wax should be avoided as this produces a foreign body reaction often requiring further exploration of the wound. It may be helpful to place the suction drain just subcutaneously to avoid a more superficial haematoma.
“Undercutting of the corresponding rib”: a novel technique of increasing the length of donor in intercostal to musculocutaneous nerve transfer in brachial plexus injury
Published in British Journal of Neurosurgery, 2023
Kuntal Kanti Das, Jeena Joseph, Jaskaran Singh Gosal, Deepak Khatri, Pawan Verma, Awadhesh K Jaiswal, Arun K Srivastava, Sanjay Behari
An obvious concern with an undercutting of a rib is the potential injury to the proximal part of the nerve, excess pain and chronic nerve irritation on the cut bony edges/callous. Separation of the periosteum from the posterior surface of the rib and enhanced vision of the operating microscope (which can provide much better magnification than operating loops) allow preservation of the nerve during rib undercutting. Postoperative pain was not a particular problem in either of our cases. Moreover, only a small portion of the rib (around 1 cm of the lower half of the rib just proximal to the origin of serratus anterior muscle) is nibbled off which will not compromise the integrity of chest wall and respiratory function. We generously applied bone wax on the raw bone surface. This is known to prevent new bone formation.9 This, however, needs to be examined prospectively in the follow-up.
Device solutions for a challenging spine surgery: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)
Published in Expert Review of Medical Devices, 2019
Arash J. Sayari, Dil V. Patel, Joon S. Yoo, Kern Singh
Preparation of the endplates can only be performed with adequate visualization of the transforaminal space including the inferior pedicle and the exiting and traversing nerve roots. At this point, the epidural veins may require coagulation with bipolar cautery. Next, pituitary rongeurs, curettes, and end plate shavers are used to create an optimal fusion bed, which can be seen intraoperatively and on lateral fluoroscopy. After trialing, it is our preference to pre- and back-fill the disc space prior to final interbody placement, which is positioned in the anterior third of the disc space to optimize lumbar lordosis. Bone wax may be placed to prevent any retropulsion of bone graft. Finally, guidewires are removed and percutaneous pedicle screws are placed with fluoroscopic guidance and connected with rods and set screws. Alternatively, one may opt to place pedicle screws first, using neuronavigation or robotic assistance. Following accurate screw placement, the surgeon can proceed with decompression and cage placement as described above.
Chronic inflammatory reaction to bone wax in cochlear implantation: A case report and literature review
Published in Cochlear Implants International, 2020
Kylen Van Osch, Peng You, Kim Zimmerman, John Yoo, Sumit K. Agrawal
Bone wax is an excellent hemostatic agent and is commonly used during bony surgeries. Present-day bone wax is composed of beeswax, paraffin, and isopropyl palmitate (Hill et al., 2013). While bone wax is largely considered to be safe, it can cause adverse effects months to years after surgery. Bone wax has been reported to cause inflammatory reactions in the areas of neurosurgery (Ateş et al., 2004; Spennato et al., 2016), cardiac surgery (Vestergaard et al., 2014), orthopedic surgery (Allen-Wilson et al., 2015; Hill et al., 2013), ophthalmic surgery (Katz and Rootman, 1996; Wolvius and van der Wal, 2003), and oral & maxillofacial surgery (Katre et al., 2010).