Subject(s)
Lipectomy , Subcutaneous Fat, Abdominal/surgery , Equipment Design , Female , Humans , Lipectomy/instrumentation , Lipectomy/methods , Middle Aged , Weight LossSubject(s)
Carcinoma, Squamous Cell/surgery , Nose Neoplasms/surgery , Rhinoplasty/methods , Surgical Flaps , Carcinoma, Squamous Cell/pathology , Humans , Lip/surgery , Neoplasms, Basal Cell/pathology , Neoplasms, Basal Cell/surgery , Nose Deformities, Acquired/pathology , Nose Deformities, Acquired/surgery , Nose Neoplasms/pathology , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
Many surgical procedures require intraoperative stimulation of peripheral nerves. Using a pair of conventional bipolar forceps and an anesthetic impulse generator (Stimlocator, Model SL3, B. Braun Australia Pty Ltd, Australia), we have developed a simple, effective, and inexpensive alternative to standard nerve stimulation devices that enables the accurate localization of motor fascicles intraoperatively. Bipolar forceps provide better control than a monopolar electrode, as the current generated across the nerve fibers generates an action potential that is then propagated down the axon. This inexpensive and reusable device is routinely used at Royal Children's Hospital, Melbourne, and its efficacy and ease of use has been demonstrated over a long period.
Subject(s)
Electric Stimulation/instrumentation , Intraoperative Care , Peripheral Nerves , Equipment Design , HumansABSTRACT
Carpal tunnel syndrome in children is uncommon. Mucopolysaccharidosis is the most common cause of carpal tunnel syndrome in this age group. With new treatment modalities available for mucopolysaccaridoses, the prognosis of the disease has greatly improved. The musculoskeletal manifestations including carpal tunnel syndrome now assume more importance. Early diagnosis and treatment of carpal tunnel syndrome in these children are important to achieve a good outcome. The authors present their experience in the management of children with mucopolysaccharidosis and carpal tunnel syndrome.
Subject(s)
Carpal Tunnel Syndrome/etiology , Mucopolysaccharidoses/complications , Carpal Tunnel Syndrome/surgery , Child , Child, Preschool , Female , Functional Laterality , Humans , Male , Neural Conduction/physiology , Neurologic Examination , Retrospective StudiesABSTRACT
BACKGROUND: Arterial occlusion in infants, although uncommon, is usually an iatrogenic event associated with arterial vascular access. Most common in the upper limb, the consequences of iatrogenic arterial occlusion may be gangrene and limb loss. Even if there is adequate collateral flow and limb loss is avoided, long-term growth disturbances may be seen. There are few published data to guide the management of arterial occlusion in premature or sick infants. In general, there is agreement regarding the importance of early diagnosis and the reestablishment of limb perfusion with the fewest risks, but the optimal choice and timing of treatment modalities remain unknown. METHODS: This article examines the authors' experiences at the Royal Children's Hospital, Melbourne, and provides their algorithm for the management of this complex iatrogenic disease. RESULTS: The management algorithm has successfully treated 11 limbs in 11 patients with arterial vascular access-associated thrombosis over the period 1995 to 2003, with no instances of limb loss. Five of these patients required surgical intervention. CONCLUSIONS: The authors recommend a multidisciplinary approach involving plastic surgeons and hematologists for all cases of suspected or confirmed arterial thrombosis. A consensus algorithm that determines the role of heparin, thrombolysis, and acute surgical interventions, and the sequence of such interventions, is useful in providing the framework of therapy. The early recognition of the limb at risk is a key factor in obtaining a successful outcome.
