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Surgical principles of amputations
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Arul Ramasamy, Aabid Sanaullah, Donatas Chlebinskas
The use of tourniquets in amputation surgery has previously been proscribed. However, Biehl et al. demonstrated that wound healing rates in diabetic and vascular patients undergoing amputation was similar in tourniquet and non-tourniquet groups (7). If a tourniquet is used, then it should be released once the amputated part is removed to check for haemostasis and flap viability prior to wound closure. Secondly, the presence of vascular bypass grafts should be identified as it is inadvisable to apply a tourniquet over such grafts.
Tissue coverage for exposed vascular reconstructions (grafts)
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kaitlyn Rountree, Vikram Reddy, Sachinder Singh Hans
Historically, Staphylococcus aureus was the leading pathogen isolated from infected vascular wounds; however, Staphylococcus epidermis is now the most common isolate. Pseudomonas species are the most common gram-negative bacteria responsible for vascular graft infection.2,4 Infection with Staphylococcus aureus is more likely to be identified in cases with anastomotic disruption between graft and native vessel.5 Predictors of surgical site infections after vascular bypass include obesity, diabetes, poor preoperative functional status, female gender, smoking, active infection at time of index surgery, and redo bypass. Siracuse et al. in a 10 year review of prosthetic graft infection observed no change in incidence of femoral artery graft infection despite changes in preoperative skin preparation, clipper versus razor use, preoperative scrub solution (Betadine vs chlorhexidine), perioperative antibiotic regimen, and conduit choice (vein vs Dacron vs PTFE) over the period of review.4
The Small Intestine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Treatment should be tailored to the individual. In conjunction with full resuscitation, laparotomy with embolectomy via the ileocolic artery or revascularisation of the SMA by vascular bypass may be considered in early cases. Anticoagulation should be implemented early in the postoperative period. However, the condition is usually diagnosed late in the disease process and the mortality rate is extremely high. In the young, all affected bowel should be resected, whereas in the elderly or infirm the situation may be deemed incurable.
From textbook to patient: a practical guide to train the end-to-side microvascular anastomosis
Published in British Journal of Neurosurgery, 2023
Jafeth Lizana, Nicola Montemurro, Nelida Aliaga, Walter Marani, Rokuya Tanikawa
The first vascular anastomosis was detailed by Eck in 1877 with his operation on dogs to create a side-to-side anastomosis of the hepatic vein to the inferior caval vein.15 The development of vascular bypass techniques and surgical magnification progressed on separate paths until the 1960s, when the merging of these 2 innovations led to the rapid growth of cerebral microvascular surgery.16,17 In 1967, Yaşargil performed the first extracranial-intracranial (EC-IC) bypass from the STA to a branch of the MCA in a dog and then he was able to perform the first EC-IC bypasses in a patient with the purpose of bypassing an occluded ICA.18 From that time, microvascular anastomosis and bypass represent a challenge for all neurosurgeons all around the world.
Two-year PAD-related health care costs in patients undergoing lower extremity endovascular revascularization: results from the LIBERTY 360° trial
Published in Journal of Medical Economics, 2021
Elizabeth A. Magnuson, Haiyan Li, Katherine Vilain, Ehrin J. Armstrong, Eric A. Secemsky, Stefanos Giannopoulos, George L. Adams, Jihad Mustapha, David J. Cohen
LIBERTY 360° enrolled patients 18 years of age or older with clinical evidence of Rutherford classification of 2 to 6 PAD and requiring endovascular intervention in one or both limbs. Enrollment criteria required a target lesion in a native vessel located within or extending into 10 cm above the medial epicondyle to the digital arteries. The type of revascularization was determined by the treating physician, and all commercially available endovascular treatment options for lower extremity PAD were allowed. Patients were considered enrolled in the study once at least one target lesion was crossed and treated without conversion to peripheral vascular bypass surgery. By design, the study cohort was divided into three study arms according to the most severe clinical syndrome based on the Rutherford classification: Rutherford 2–3 (up to 500 subjects); Rutherford 4–5 (up to 600 subjects); and Rutherford 6 (at least 100 subjects). Following their index revascularization procedure, enrolled patients had follow-up office visits at 30 days, and 6, 12, and 24 months. At each follow-up visit, both inpatient and outpatient PAD-related healthcare resource use reported by the patient were recorded. In addition, the protocol included the collection of hospital bills for the index procedure and any PAD-related hospitalizations reported during follow-up.
Surgical treatment of foreign body embolus in the Middle cerebral artery secondary to neck injury
Published in British Journal of Neurosurgery, 2020
Hui Wang, Xin-Jie Ning, Chuan Chen, Cong Lin, Jia-Ji Liang, Yu-Zhang Li
Currently, there are three surgical methods for the management of foreign body embolus in intracranial arteries. The first method is retrograde displacement combined with artery occlusion. Craniotomy is performed to locate the foreign body, which is retrogradely removed from the MCA to the internal carotid artery without surgical incision of the arteries. Then, the foreign body is isolated after temporal occlusion of the internal carotid artery. This surgical procedure is only applied in cases in which the foreign body is not closely adhered to the arterial wall and the circle of Willis is normal. The second method is arteriotomy and suturing for removal of foreign body, which is a simple and optimal method to restore the blood flow to normal levels. During this surgical intervention, the foreign body–induced granulation tissue should be removed along with the foreign body. Finally, the third method is extracranial-intracranial (EC-IC) vascular bypass.24 If the arterial injuries induced by the foreign body cannot be repaired, EC-IC vascular bypass is an option. In our case, the superficial temporal artery was retained with this in mind.