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Surgery of the Thoracolumbar Spine
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daniel P Ahern, Joseph S Butler, Matthew Shaw, Sean Molloy
Incision: Skin: Note the pedicle entry point will be above the spinous process of the vertebra counted and therefore the skin incision should allow for this
The thorax
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
Although the most frequent indication for thoracotomy is lung cancer, all surgeons dealing with trauma should be able to perform a thoracotomy if required. The standard route into the thoracic cavity is through a posterolateral thoracotomy. The incision is used for access to the:
Carotid endarterectomy
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
The neck is hyperextended by a roll behind the scapulae and an occipital support. The neck is turned toward the contralateral site. Incision options include a vertical, transverse, or oblique incision; the latter is often preferable because of better cosmetic results. If the plaque extends considerably distally into the ICA or proximally into the CCA, a transverse incision may not provide adequate exposure. In patients with short necks, adhesive tape is applied to the shoulder, pulled downward, and attached to the operating table to improve exposure in the space between the clavicle and mandible.
Exploring 5-minute heart rate variability in spinal cord injury during acute inpatient rehabilitation
Published in The Journal of Spinal Cord Medicine, 2023
Argyrios Stampas, Colton Malesovas, Michael Burke, Sahira Farooq, Mani Singh, Radha Korupolu, Sheng Li
Clinical outcomes of interest throughout their admission were obtained from the EMR. The definition used for OH was a decrease of systolic (SBP) and/or diastolic blood pressure (DBP) by 20 mmHg or 10 mmHg, respectively, upon standing from a seated position.13 The definition of AD is considered a sudden increase in systolic blood pressure ≥ 20 mmHg above baseline.14 Because the SNS is implicated in the immune system dysregulation that occurs after SCI, we recorded all infections in the participating patients.15 Infection was defined by the presence of at least one of the following: urinary tract infection (UTI), pneumonia, cellulitis, surgical infection, or other stated infection. UTI was defined by symptoms known to occur in SCI, a positive UA with bacterial growth in urine culture, with symptom improvement after appropriate antibiotic treatment.16 Pneumonia was diagnosed by pathologic chest X-ray infiltrates. Surgical infections were diagnosed by fever greater than 100.8 degrees Fahrenheit with erythema, tenderness, and/or discharge originating from surgical incision site.17
Modified vertical lid split orbitotomy: a case series and literature review
Published in Orbit, 2023
Jacqueline H. C. Tai, Kenneth K.H. Lai, Andrew K.T. Kuk, Edwin Chan, Callie K. L. Ko
All surgeries are performed under general anesthesia. Before the surgery, the eye is irrigated with 5% povidone-iodine for 3 minutes. Local anesthesia with 1:20000 adrenaline is injected subcutaneously into the eyelid along the preseptal plane to enhance hemostasis. An initial transverse incision is made along the upper lid crease or lower lid subciliary line with a No. 11 surgical scalpel blade. From the transverse incision to the orbital rim, we undermine the skin from the subcutaneous tissue. Then, a full thickness vertical incision is initiated from the lid margin to the transverse incision and then continued subcutaneously from the transverse incision to the respective upper or lower fornix (Figure 1). The vertical incision is made at the junction between the medial third and central third of the lid using Westcott scissors. We enter the intraconal space by incision of the septum between the superior and medial rectus. Retractors are used to enhance the intraconal exposure once posterior to the septum to protect the globe and extraocular muscles. After identification and excision of the intraconal lesion haemostasis must be done adequately. The tarsal plate is realigned at the lid margin with 7-0 Vicryl suture passing through the meibomian gland orifice, and the remainder of the vertical lid split is repaired using 7-0 Vicryl via partial thickness mattress sutures. The horizontal skin wounds along the lid crease or subciliary line are repaired using 6-0 Vicryl sutures (Figure 2). We monitor the patient at day 1, 7, 14, 28, 56, and 84 after the operation.
Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy – Success Rates and Related Factors During 3 Years of Follow-Up
Published in Seminars in Ophthalmology, 2021
Christophe Pinto, Tatiana Queirós, Carla Ferreira
External DCR possesses a long track record reporting functional success rates greater than 90% and its results are still the best.5 A substantial reason for its slightly higher effectiveness is that the osteotomy created is bigger and consequently less likely to be obstructed by newly formed scar tissue - the major cause of DCR clinical failure.6 Another major advantage is its diagnostic purpose when secondary obstructions are suspected.7 Commonly noted disadvantages of this approach include usually requiring general anesthesia, longer operative times, risk of complications like perioperative bleeding, longer convalescence, violation of the physiological lacrimal-canalicular tear pump mechanism, and cutaneous scarring at the incision site.5 A survey study with external DCR reported visible scars in 19.4% of the subjects and 10.3% described their scars as cosmetically significant, causing dissatisfaction, especially among the younger patients. However, recent studies have shown modifications in incision as well as suturing techniques that reduced the risk of scarring to such an extent that it is not considered a disadvantage anymore.8