[Surgical treatment of cervical rib syndrome].

The authors report herein the results of examination and surgical management of fifty-one patients presenting with cervical ribs. Of these, there were 33 women. Compression of the neurovascular bundle (NVB) was found to be caused by a supplementary cervical rib in twenty-three patients while in the remaining 28 patients by a rudimentary cervical rib. Twenty-two patients were found to have clinical manifestations of Raynaud's syndrome. The presence of abnormal cervical ribs was determined roentgenologically. All the patients with rudimentary cervical ribs and twelve of the 23 patients with supplementary cervical ribs were diagnosed as having bilateral abnormalities. Haemodynamics was studied by Doppler ultrasonography revealing blood flow impairments in upper-limb arteries in Edson's test in patients with supplementary cervical ribs and Raynaud's syndrome. In rudimentary cervical rib - only in the development of Raynaud's syndrome. The nervous function was studied by means of electroneuromyography (ENMG). All the patients were diagnosed as having a significant decrease in both motor and sensitive nervous conductivity of the radial and median nerves. All patients were operated on under endotracheal anaesthesia. Decompression operations were carried out in fifty-one patients, with selective thoracocervical sympathectomy performed in twelve. For treating rudimentary cervical rib, we worked out a combined method of an operative intervention. Analysing the obtained surgical outcomes showed the following: forty-four patients (86.3%) endured the operation with no complications. Intraoperative complications were noted to occur in 5.9% of patients and complications in the immediate postoperative period were observed to develop in 7.8% of patients. All the encountered complications turned out transient, easily amendable to treatment, and did not influence the final outcome of the operation. In the remote period up to 5 years positive results remained in 90.2% of the patients.

[Falconer-Weddel's costoclavicular syndrome].

Analysed herein are the findings of examination and outcomes of surgical management of fifty-eight patients (25 men and 33 women) presenting with Falconer-Weddel's costoclavicular syndrome in which the subclavian artery and vein and the brachial plexus at the thoracic outlet appear to be compressed. Of the 58 patients,five subjects were found to have a rudimentary cervical rib and three more (5.3%) patients had trophic disorders on their digits fingers: dystrophy of the nail plates, their fragility, periodically opening trophic ulcers at the digital tips and one patient presented with gangrene of the inguinal phalanx of the middle finger. Three patients had hyperemia of the face. A further four patients had roughening, hyperkeratosis of the skin of the hands, cracks. The presence of the supernumerary ribs was determined roentgenologically. Haemodynamics was studied using Doppler ultrasonography making it possible to reveal disordered blood flow in the upper-limb arteries in the physiological position assumed, in the Adson test as well as with Raynaud syndrome, which was observed in 39 patients. The function of the nerves was studied using electroneuromyography (ENMG). All patients were operated on under endotracheal anaesthesia. Decompression-medical operations were carried outperformed in all 58 patients, with the following four types of interventions being performed: transaxillary resection of the first rib combined with sympathectomy carried out in 23 patients, resection of the first rib without sympathectomy in eighteen patients, resection of the first rib via a surpraclavicular approach in four patients, scalenotomy and selective cervicothoracic sympathectomy in 13 patients.

Traumatic injuries of the popliteal and tibial arteries: limb ischemia and problems of surgical management.

This paper analyzes the results of examination of 106 patients with traumatic injuries of the popliteal (n=36) and leg arteries (n=70) including gunshot (n=48), punctured and incized (n=32), contused-crushed (n=17) wounds and blunt (n=9) traumas. Sixty-two patients were admitted within 8 hours of injury and 20 within 8 to 24 hours, 24 patients within 1 to 15 days. Sixty-five patients had been rendered first aid at other medical institutions. It is to be noted that the prehospital diagnostic and tactic errors had been made in 67.7% of cases. In the patient group with injuries of the leg arteries, the severity of ischemia correlated with the number of the injured arteries and in the group of patients with popliteal artery injuries, there was a relationship between the severity of ischemia and the character of injury. In injury of the popliteal and leg arteries, severe limb ischemia was present in 72.2 and 34.3% of cases respectively. The surgical management was worked out depending on the severity of the patient general condition and the degree of limb ischemia. Primary limb amputation was performed in 17 (16%) patients; the indications for it were moist gangrene, severe traumas with major destructions and defects of other anatomic structures (inadvisability of revascularization), critical condition of the casualty, severe circulatory decompensation observed even in the early times of referral, when it was necessary to save the patient's life. Different surgical interventions were undertaken in 89 patients: ligation of the vessel in the event of one artery injury (24), revascularization (61) and fasciotomy, hematoma evacuation and bone reposition (4). Eleven (10.4%) patients underwent secondary amputation. Beneficial results with complete circulatory compensation were obtained in 78 (73.6%) patients. The total incidence of amputation and lethality accounted for 26.4%.

[Surgical strategy in traumatic lesions of the popliteal artery]. / Khirurgicheskaia taktika pri travmaticheskikh povrezhdeniiakh podkolennoi arterii.

An examination and treatment of 32 patients with injured popliteal arteries are analyzed. Among the etiological factors there were gunshot wounds (16), crushed (4), punctured-incised (7) and blunt (7) traumas. Combined injuries of the popliteal vein were diagnosed in 12 patients, and injuries of the bones--in 16 patients. Errors were made in 19 cases at the prehospital stage: late diagnosis of the injury (11), transporting the patient in the state of shock (5), ligation of the popliteal artery (3). The term of extremity ischemia more than 8 hours was noted in 13 admitted patients. Decompensation of circulation was diagnosed in 22 patients. The primary amputation was performed on 6 patients with moist gangrene. Vascular reconstructions were made in 26 cases including the autovenous prosthesis and circular suture. Secondary amputations were fulfilled to 6 patients. Three patients died. Good results were obtained in 20 cases.

Surgical management of traumatic injuries to the tibial arteries.

Altogether 60 patients with traumatic injuries to the tibial arteries were entered into the study. Twenty-four patients presented with gunshot, 24 with stab and incised, 10 with contused and lacerated wounds, and 2 patients had blunt traumas. Thirty-nine patients were admitted to the clinic within the period as long as 8 hours since the time of wounding, 9 patients within 8 to 24 hours, and 12 patients within the period as long as one to 15 days. 39 patients had been rendered first medical aid at other treatment institutions. It was established that prehospital diagnostic, tactic and technical errors had been made in 25 of the 39 patients. All the patients were distributed into three groups: group I (n=8) included patients with isolated injuries of one of the tibial arteries; group II (n=11) with injuries of two arteries and group III included patients with damage to all three arteries. In group I, circulation remained made for irrespective of the times of ischemic state existence. In groups II and III, all the patients demonstrated circulatory decompensation. Surgical management depended on the severity of the general condition and the degree of limb ischemia. Primary amputation was indicated to 11 (18.3%) patients (humid gangrene was diagnosed in 5 patients, severe trauma with major defects of soft tissues and bone fractures in 6 patients). The remaining 49 victims underwent different surgical interventions such as ligation of the vessel at injury to one artery (23); revascularization (22); fasciotomy, hematoma evacuation and reposition of the bones in an isolated form (4). Five (10.2%) patients required secondary amputation. Beneficial results with complete circulatory compensation were obtained in 44 (73,3%) patients. The overall amputation rate accounted for 26.6%.