Case 1.6
Monica Fawzy in Plastic Surgery Vivas for the FRCS(Plast), 2023
The purpose of decompression is to rescue threatened muscle and nerve, so if these are already necrotic then there is no need to decompress. If anything, this would risk further morbidity – with infection and even death:If the diagnosis or presentation is delayed by more than 10 hours, I would obtain an MRI to evaluate the state of the muscles, as irreversible muscle damage is thought to start to occur at 8 hours. This will provide radiological confirmation regarding the progression of rhabdomyolysis to myonecrosis – with early ischaemic changes seen as a hyperintense signal on MRI, versus irreversible myonecrosis with complete lack of signal enhancement – in which case I would not operate.In addition, I would not operate if the diagnosis were delayed by 3 days, as widespread irreversible myonecrosis would have already occurred – with no need for imaging to confirm this.Lastly, I would not decompress a foot – even if acute – as morbidity of the procedure outweighs that of the sequelae, which is simply clawed toes.
Neurosurgery: Minimally invasive neurosurgery
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
This is another minimally invasive decompression surgery that helps to relieve the pressure on the spinal cord or nerve roots. Compared to open cervical foraminotomy, it is associated with lower blood loss, less pain, and shorter duration of hospital stay. These procedures are usually carried out under general endotracheal anesthesia. The intraoperative evoked potential monitoring requires total intravenous-based anesthesia with omission of muscle relaxants. The anterior cervical foraminotomy helps to treat ventral radiculopathy without the need for discectomy, obviating the need for any arthrodesis or neck collar. Injury may occur to nerve root, blood vessels, or to sympathetic chain, resulting in Horner syndrome. Posterior cervical microforaminotomy is used to treat foraminal stenosis due to degenerative changes such as osteophytes or lateral disc herniation (29). It may be carried out in the prone or sitting position. Injury to dura, nerve root, or blood vessels may occur. Vertebral artery injury is a dreaded complication and requires control with gelfoam packing. In an uneventful case, patients are woken and trachea extubated at the end of surgery.
Ear Trauma
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
As many as 70% of all divers with this condition have followed their decompression tables correctly, many reports occurring after shallow sport dives.345 The diagnosis may be very difficult to distinguish from inner ear barotrauma, especially as both often coexist with middle ear barotrauma. A careful history of the dive profile, the timing of the onset of symptoms, and their exact nature, is essential. The verification of the dive history is usually straightforward as many divers now carry electronic dive computers that provide at least a depth/time printout. The onset of decompression illness symptoms is usually only a few minutes (but may be as long as up to 36 hours) after surfacing. A history of symptoms starting when returning from a diving holiday by air is not uncommon as fiying after diving may exacerbate, or even cause, decompression illness.346 There is an increase in the tendency for more nitrogen to come out of solution due to the lower partial pressures of the inspired air and the decreased ambient pressure at altitude.
Possible predictive clinical and radiological markers in decision making for surgical intervention in patients with Chiari Malformation type 1
Published in Neurological Research, 2022
Ulaş Yuksel, Veysel Burulday, Suleyman Akkaya, Selcuk Baser, Mustafa Ogden, Aslihan Alhan, Bulent Bakar
Although the surgical treatment, including posterior fossa decompression in CM, has been a challenge for neurosurgeons for nearly 100 years, it still is one of the most recommended methods for treatment of CM type 1 in the literature [3]. The purpose of decompression is to relieve compression of the hindbrain and cervical spinal cord caused by the abnormal anatomical configuration of the posterior fossa, thereby improving cerebrospinal fluid (CSF) flow dynamics [4]. It has been reported in the literature that approximately 80% of CM type 1 patients benefit from surgical treatment, but the remaining 20% of patients showed no improvement after surgery [5]. Some studies have reported that the percentage of adverse outcomes after posterior fossa decompression may be as high as 30%, and this high rate of adverse outcomes has been attributed to poor patient selection rather than surgical procedure [6–8]. Many studies constructed to predict the efficacy of decompression in CM type 1 patients have considered symptoms, syringomyelia, CSF dynamics, or posterior fossa volumetric changes. However, few studies have attempted to predict the decision-making for surgical intervention based on preoperative posterior fossa morphology [6,9–11].
Biomechanical effect of intervertebral disc degeneration on the lower lumbar spine
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Hongkun Wang, Nan Li, Huiwen Huang, Peng Xu, Yubo Fan
Lumbar intervertebral disc degeneration can induce bone hyperplasia, lumbar intervertebral disc herniation and other diseases, is one of the causes of low back pain. Lumbar intervertebral disc herniation occurs between 20 and 40 years old, and there are more males than females. The prevalence rate is 37% in people aged 20 and 96% in people aged 80 (Kersten et al. 2014; Zhou et al. 2022). And with the acceleration of people’s pace of life, the incidence of lumbar disc herniation is increasing yearly, which seriously affects people’s normal working state and quality of life. However, the cause of intervertebral disc degeneration is still not very clear, so to explore the internal mechanism and influence of lumbar intervertebral disc degeneration is of great significance to explore the cause of this disease. Therefore, it is important to understand the underlying mechanisms of lumbar disc degeneration when analyzing the basic principles of spinal biomechanics, selecting the best treatment, or developing new surgical equipment (Wang and Fan 2020). Clinically, surgical decompression is commonly used to relieve symptoms (Huang et al. 2017; Wang et al. 2017, 2021).
Short-Term Outcomes of Self-Expandable Metallic Stent versus Decompression Tube for Malignant Colorectal Obstruction: A Meta-Analysis of Clinical Data
Published in Journal of Investigative Surgery, 2020
Fu-Gang Wang, Ri-Xing Bai, Ming Yan, Mao-Min Song, Wen-Mao Yan
Our study was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist [12]. The PRISMA flow chart of study inclusion was shown in Figure 1. Comprehensive checks of the references from the eligible studies and related reviews revealed no additional eligible study, which indicated that our search strategy was satisfactory. Totally, 7 cohort studies [5,9,10,13–16] were enrolled in our meta-analysis. The basic characteristics of eligible studies and the procedure-related outcomes were shown in Table 1. A total of 312 patients were included in the 7 eligible studies (147 patients in SEMS group and 165 patients in the DT group). The sample size of each group for single study ranged from 12 to 45. Two eligible studies [10,14] limited their patients to left side colon (rectum, sigmoid colon, descending colon, and splenic flexure). The remaining 5 studies [5,9,13,15,16] limited their patients to total colon. The duration of decompression ranged from 6 to 17 days. All the 7 eligible studies proved to be high quality according to the NOS scale. The surgery-related outcomes and NOS scores were shown in Table 2.