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Equinovarus
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Nicholas Peterson, Christopher Prior, Selvadurai Nayagam
The procedures were performed under general anaesthesia with regional blocks. Through a postero-medial approach, z-lengthening of the Achilles tendon and the tibialis posterior was performed, but the tendons were not sutured at this stage. A modified Ollier’s4 curvilinear incision was used to perform the triple arthrodesis (Figure 2.2). Care was taken to protect the sural and superficial peroneal nerves. The extensor digitorum brevis (EDB) was elevated with sharp dissection from proximal to distal, and the fat was removed from the sinus tarsi (Figure 2.3). The anterior process of the calcaneum was osteotomised (Figure 2.4). The anterior facet of the subtalar joint, head of the talus and the talonavicular joint were identified. An elevator was passed deep to the peroneal tendons and the tendons retracted posteriorly, exposing the capsule over the posterior facet of the subtalar joint. The capsule was removed using a rongeur. The calcaneocuboid joint and the talonavicular joint were exposed and their capsules excised (Figure 2.5).
Chest wall deformities
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert E. Kelly, Marcelo Martinez-Ferro, Horacio Abramson
Bars are removed electively between 2 and 4 years after placement. Bar removal is performed under general anesthesia, using positive end-expiratory pressure (PEEP) to minimize the risk of a pneumothorax. We recommend opening all incisions and mobilizing both ends of the bar (Figure 20.19a). It is not uncommon to encounter significant calcifications that require a rongeur and/or chisel to remove. Once the stabilizer is removed, the bars are unbent using Biomet bar flippers or alternatively Biomet Multi-Benders (Figure 20.19b). The bars are then removed from the either side gently under positive pressure ventilation using an orthopedic bone hook (Figure 20.19c). We routinely perform bar removals as an outpatient procedure and the use of postoperative narcotics is minimal.
Revision surgery for proximal junctional kyphosis following thoracolumbar fusion
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Sundeep S. Saini, Daniel Cataldo, Christopher R. Cook, Hamadi Murphy, Paul W. Millhouse, Kris Radcliff
For this reason, surgeons should be familiar with the relative location of the transverse process in reference to the pedicles at every vertebral level. The axial trajectory of thoracic pedicles is perpendicular to the superior articular process, while sagittal trajectory is often parallel to the transverse process. A rongeur is used to remove the dorsal cortex of the transverse process, allowing identification of the pedicle starting point using a high-speed burr. Once the starting point is determined, a curved pointed gearshift can be used for pedicle screw insertion. The probe is advanced 15 mm, with the tip pointing laterally. At this point, the tip of the instrument should traverse the pedicle. The gearshift tip is then rotated and pointed medially for 15 mm, as the tip should be in the vertebral body. An awl is advanced a total of 35 mm, and the hole is then palpated to rule out the existence of any breach medially, laterally, superiorly, or inferiorly. Tapping is not recommended in order to maximize screw purchase while creating a new bony path. Trajectory should be confirmed prior to final screw placement using a drill bit and image-guided fluoroscopy.
Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review
Published in The Journal of Spinal Cord Medicine, 2023
Carina Fähndrich, Armin Gemperli, Michael Baumberger, Marco Bechtiger, Bianca Roth, Dirk J. Schaefer, Reto Wettstein, Anke Scheel-Sailer
All approaches describe a debridement as the baseline of surgical treatment because it is the most efficient method of wound cleaning.3,5–7,9,11,15,31–35 During the surgical debridement, all necrotic tissue and infected bone should be removed.3,5,33,34 The debridement can be carried out with a scalpel, electrocautery, rongeur or curette.3 Moreover, anesthesia is often indicated because of autonomic dysreflexia, pain and/or bleeding.3 Ljung et al. and Rieger et al. perform the debridement with pseudotumor technique.6 In this procedure, the wound margin is incised at a sufficient distance in healthy tissue, the ulcer margins are sutured together with retaining sutures and the ulcer is excised, taking any necrosis and surrounding scar tissue with it.5 Furthermore, Tadiparthi et al. mention to use methylene blue in order to trace the extent of any sinus tract formation.7 Ljung et al. remove the underlying bone and make it smooth and less prominent.6 Debridement and surgical closure in the same procedure was described by Ljung et al. and Tadiparthi et al.6,7 In contrast, Jordan et al., Kreutzträger et al., Sørensen et al. and the Consortium for Spinal Cord Medicine prefer serial debridement, especially in cases of heavy bioburden.3,9,15,31
Fraxetin protects rat brains from the cerebral stroke via promoting angiogenesis and activating PI3K/Akt pathway
Published in Immunopharmacology and Immunotoxicology, 2022
Yuhuan Cui, Meihong Liu, Li Zuo, Haiyan Wang, Jian Liu
Blood–brain barrier permeability in ischemic hemispheric tissue was determined via detecting the Evans blue extravasation. Evans Blue (E2129, Sigma-Aldrich) was dissolved in 0.9% normal saline (ST341, Beyotime, Shanghai, China) to obtain a concentration of 2%, and then intravenously injected to the tail of three rats in each group after 24 h reperfusion at a dosage of 3 mL/kg. After deep anesthesia, rats were transcardially perfused with normal saline to remove the intravascular Evans blue dye. Afterwards, the rats were sacrificed and their skulls were opened using rongeur (S21011-15, RWD life technology Co., Ltd, Shenzhen, China). Subsequently, their brains were collected and the entity or part images were taken. The ischemic hemispheres were weighed and homogenized with 50% trichloracetic acid (T0699, Sigma-Aldrich). The supernatants after centrifugation were collected and measured at a wavelength of 620 nm. Finally, the concentration of Evans blue was calculated using a standard curve. The Evans blue leakage was exhibited as nanograms per microgram of wet tissue.
Pelnac® Artificial Dermis Assisted by VSD for Treatment of Complex Wound with Bone/Tendon Exposed at the Foot and Ankle, A Prospective Study
Published in Journal of Investigative Surgery, 2020
Zhenmu Lv, Qiusheng Wang, Rui Jia, Wenyuan Ding, Yong Shen
For every patient, 2 separate operations were performed. The first procedure involved thorough debridement of necrotic tissues, meticulous hemostasis, and then immediate coverage of VSD at continuous negative pressure suction. For bone exposure in adult case, a rongeur forcep was used to remove the necrotic tissues and a kirschner wire was used to slightly drill into the exposed bone surface to induce punctate bleeding; in children case, the surgical knife blade was used for the slight bleeding. For cases with tendons exposed, the contaminated tissues around were cleared, with aponeuroses protected carefully. After adequate hemostasis was controlled, the artificial dermis Pelnac was trimmed to the appropriate size and shape to achieve a tension-free closure and interrupted 3-0 or 4-0 absorbable stitch was used to suture the artificial dermis to the surrounding skin. The overlying silicone layer was stabbed with No.11 scalpel blade to facilitate drainage of effusion. Immediate coverage with VSD was applied, for 2–3 weeks. Afterwards, VSD was removed and the wound surface was inspected. Based on the freshness of the wound bed, a second debridement and VSD coverage or artificial dermis coverage was performed.