Journal of reconstructive microsurgery
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J Reconstr Microsurg · Jul 1998
Comparative StudyFlap flow and cardiac output as functions of pulmonary artery wedge pressure: experimental study in the pig.
Cardiac output (CO) is redistributed during hypovolemia, but it has not been clearly documented how this influences flap perfusion. Simultaneous changes in perfusion of a muscle flap and CO as modulated by reductions in cardiac filling pressure were compared in a pig model. The hypothesis was that flap flow (FF) would remain relatively constant as CO was reduced, according to the Frank-Starling curve. ⋯ Changes in FF paralleled changes in CO as the PAWP was reduced. Inhalation anesthesia and local sympathectomy may influence flap perfusion during hypovolemia. These results underscore the importance of avoiding hypovolemia during flap surgery, in order to maintain flap perfusion.
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J Reconstr Microsurg · Jan 1998
Case ReportsOne-stage reconstruction of post-electrical burn forearm and hand defects using microsurgical transfer of an ulnar neuromyotendinocutaneous unit.
Three cases of high-voltage electrical burns of the wrist and forearm were reconstructed, using vascularized ipsilateral ulnar nerve transfers to median-nerve defects. Two of these cases utilized composite ulnar neuromyotendinous flap transfers, with the muscle (flexor carpi ulnaris) bridging the gap between the flexor muscle bellies and tendons. Sensory recovery in the hand was excellent in all three cases.
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J Reconstr Microsurg · Jan 1998
Continuous peripheral nerve block in replantation and revascularization.
Continuous infusion of a local anesthetic by means of a percutaneous forearm catheter and an infusion pump was studied for its utility in achieving sympathetic blockade following replantation and revascularization of the digits. The efficacy of the technique was demonstrated by cold stress testing. ⋯ The analgesia obtained from the nerve block benefited patient comfort during hospitalization, and normal sensibility in the uninjured digits returned promptly after discontinuing the anesthetic in all but one patient. The reported study indicates that continuous peripheral nerve block by means of an indwelling forearm catheter is a safe and effective adjunct in preventing neurogenically-mediated vasospasm.
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J Reconstr Microsurg · Jan 1998
Monitoring spinal-cord injury intraoperatively and attempting prognosis by cortical somatosensory evoked potentials: experimental study.
In order to monitor spinal-cord injury intraoperatively and to evaluate prognosis by cortical somatosensory evoked potentials (CSEP), the spinal-cord function of 42 dogs, whose cords were injured by air-sac pressure or various striking trauma, was monitored by CSEP intraoperatively and 1 to 3 months postoperatively. Although amplitude declined by 100 percent, compared with preoperative readings, spinal-cord injury by air-sac pressure had no lasting effects. ⋯ The change in amplitude was quite sensitive and its recovery was earlier than morphologic changes and functional recovery. Results indicated that CSEP monitoring of spinal-cord injury intraoperatively is accurate and reliable and that it can also predict an accurate prognosis for the injured spinal cord in this canine model.
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J Reconstr Microsurg · Aug 1997
Comparative StudyThe effect of ammonium sulfate injection on peripheral nerve.
Local anesthetic drugs with prolonged nerve-block effect would have clinical application for postoperative or neuromatous pain relief. This study evaluated the possibility of peripheral nerve neurotoxicity by injection of 10 percent ammonium sulfate. ⋯ Using histologic studies and motor function evaluation with walking-track analysis, 10 percent ammonium sulfate was found to be neurotoxic when it is injected intrafascicularly; however, extrafascicular injection of this drug did not cause significant nerve injury. The neurotoxicity of the 10 percent ammonium sulfate solution was intermediate between the neurotoxicity of 0.1 percent lidocaine hydrochloride and the marked neurotoxicity of 5 percent phenol solution.