ABSTRACT
BACKGROUND: Open surgical correction is effective in the treatment of craniosynostosis but may result in significant blood loss and transfusions. This study seeks to compare surgeon estimated blood loss with calculated blood loss and provide contemporary data that objectively quantify blood loss and transfusion rate associated with open repair of craniosynostosis. METHODS: A retrospective review of patients undergoing primary open repair of craniosynostosis between May 2011 and November 2016 was performed. The medical records of 43 patients were reviewed to obtain the operative age, weight, affected suture, pre- and postoperative hematocrit, blood transfusion volume, estimated blood loss, and syndromic status. Estimated blood volume (EBV) and red cell mass were calculated for analysis. RESULTS: The median age and weight at the time of surgery were 9 months and 8.6 kg, respectively. Mean surgeon estimated blood loss was 207.4 mL (28.1% of EBV). Mean calculated blood loss was 318 mL (44.3% of EBV). The mean transfusion volume was 188 mL (26.5% of EBV). The mean transfusion as a percent of estimated red cell mass was 59.1%. Fourteen percent of patients did not require any transfusion. CONCLUSIONS: We report intraoperative blood losses and transfusion requirements that are lower than those of many previous studies of open repair of craniosynostosis. Additionally, we found that calculated blood loss estimates may be more reliable than surgeon-derived estimated blood loss. We hope that these updated, objective data will be useful in comparisons of open repair to minimally invasive surgery or to new blood loss reducing procedures.
ABSTRACT
BACKGROUND: Vascularized lymph node transfer has recently received attention as a potential surgical treatment for lymphedema. Despite good results in some series, the mechanism and benefits of vascularized lymph node transfer have yet to be fully understood. This study aimed to investigate the reestablishment of drainage into transferred lymph nodes following vascularized lymph node transfer in a rat model. METHODS: Seven rats underwent vascularized lymph node transfer. The operation performed on each rat consisted of two parts. First, the left groin lymph node basin with superficial epigastric vessels was harvested as a free flap. Second, the flap was reattached in the left groin of the rat by means of end-to-end microvascular anastomoses. Anastomosis patency was assessed immediately postoperatively and at the time of animal sacrifice. The rats were evaluated for reestablishment of lymphatic flow into the transplanted nodes at 1-month intervals for at least 6 months postoperatively. This was accomplished noninvasively by injecting the rats in their flanks with fluorescent indocyanine green, which was detected using a Photodynamic Eye infrared camera. RESULTS: Anastomoses were patent in all seven rats immediately postoperatively. No indocyanine green uptake was seen in the transplanted lymph node basins in the first 2 months postoperatively in any of the rats. In five of seven rats, however, indocyanine green uptake was demonstrated in the transplanted lymph node basin by 6 months (average, 13 weeks). CONCLUSION: The authors report uptake of indocyanine green in five of seven rats at an average of 13 weeks after lymph node transplantation, consistent with the reestablishment of lymphatic drainage into the transplanted nodes.
