Surgical and radiologic anatomy : SRA
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Stellate ganglion blockade (SGB) has long been considered pivotal in the diagnosis, determination of prognosis and management of chronic regional pain syndrome (CRPS) by sympathectomy. To date a variety of SGB techniques have been described. An inaccurate SGB may mislead clinicians and deny patients a potentially beneficial procedure. ⋯ This modified technique demonstrated that the lower cervical ganglia and proximal thoracic sympathetic trunk were consistently stained. It should be noted that the spread was sufficiently lateral to block the nerve of Kuntz. The pitfalls of this technique aside, we suggest that this technique be reserved for therapeutic purposes, particularly when sympathectomy is not possible.
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Anterior cruciate ligament (ACL) reconstruction with autogenous semitendinosus and gracilis tendons has become a common surgical procedure. Lower leg paresthesia following injury to the infrapatellar nerve during harvesting of the tendons has been well documented. Few authors have described the position of the infrapatellar nerve on a flexed knee, which is the position used during ACL reconstruction. ⋯ A safe area on the right knee was determined to be on the tibial tuberosity plane between 3.7 and 5.5 cm with a safe angle of incision of 51.6 degrees. A safe area on the left knee was determined to be on the tibial tuberosity plane between 3.6 and 4.9 cm with a safe angle of incision of 52.5 degrees. The results may assist orthopedic surgeons performing ACL reconstruction with semitendinosus and gracilis tendons to avoid cutaneous nerve damage and, therefore, patient discomfort.