ABSTRACT
BACKGROUND: Chest tube placement is a frequently required surgical procedure among patients in the emergency department. Although the procedure is often simple, occasionally there are known complications, including unresolved pneumothorax or hemopneumothorax, extrathoracic placement of the tube, and damage to the intercostal neurovascular bundle. OBJECTIVES: We report an unusual yet noteworthy complication of ulnar neuropathy after chest tube placement for pneumothorax. Awareness of the association between acute ulnar neuropathy and chest tube placement will alert the physician to reposition the tube and prevent ongoing compression. CASE REPORT: A 43-year-old man developed right-sided rib fractures (6-9 and 12) and a pneumothorax from blunt trauma to the right chest wall. Upon insertion of a 36 French chest tube, the patient reported immediate ulnar nerve distribution paresthesias of the ipsilateral arm. The tube was subsequently repositioned with improvement of symptoms. He was later discharged with occupational therapy outpatient follow-up. CONCLUSION: Ulnar neuropathy is a rare, though significant, complication associated with tube thoracostomy. Management of persistent symptoms is expectant, with early upper extremity range of motion and strength exercise.
Subject(s)
Chest Tubes/adverse effects , Hypesthesia/etiology , Paresthesia/etiology , Ulnar Nerve/injuries , Adult , Forearm , Humans , Male , Pneumothorax/therapy , Thoracostomy/adverse effectsABSTRACT
As the technique of autologous fat grafting is being refined and perfected, its clinical applications are expanding. The use of autologous fat grafting for primary breast augmentation is controversial due to a lack of clarity regarding its safety and efficacy. Most notably, concerns about interference with the detection of breast cancer have been raised, but these have not been clearly addressed in the literature. To help surgeons gain further insight, the authors conducted a systematic review of the literature, carefully comparing technique, clinical outcome, radiologic impact, and complications in all available data on this subject. Although an optimal method of autologous fat grafting for primary breast augmentation is yet to be standardized, further strong evidence-based studies are necessary to confirm the findings of this approach.
Subject(s)
Abdominal Fat/transplantation , Adipose Tissue/transplantation , Mammaplasty/methods , Adult , Aged , Esthetics , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Humans , Mammaplasty/adverse effects , Middle Aged , Postoperative Care/methods , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Risk Assessment , Transplantation, Autologous , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery. BACKGROUND: Hemorrhage is a significant complication after major gastrointestinal and abdominal surgery. Clinically significant bleeding can lead to shock, transfusion of blood products, and re-operation. Recent reports suggest that activated rfVIIa may be effective in correcting coagulopathy and decreasing the need for re-operation. METHODS: This study was a retrospective review over a 4-year period of 17 consecutive bleeding postoperative patients who received rfVIIa to control hemorrhage and avoid re-operation. Outcome measures were blood and clotting factor transfusions, deaths, thromboembolic complications, and number of re-operations for bleeding. RESULTS: Seventeen patients with postoperative hemorrhage following major abdominal gastrointestinal surgery (nine pancreas, four sarcoma, two gastric, one carcinoid, and one fistula) were treated with rfVIIa. In these 17 patients, rfVIIa was administered for 18 episodes of bleeding (dose 2,400-9,600 mcg, 29.8-100.8 mcg/kg). Transfusion requirement of pRBC and FFP were each significantly less than pre-rfVIIa. Out of the 18 episodes, bleeding was controlled in 17 (94%) without surgery, and only one patient returned to the operating room for hemorrhage. There were no deaths and two thrombotic complications. Coagulopathy was corrected by rfVIIa from 1.37 to 0.96 (p < 0.0001). CONCLUSION: Use of rfVIIa in resuscitation for hemorrhage after non-traumatic major abdominal and gastrointestinal surgery can correct dilutional coagulopathy, reducing blood product requirements and need for re-operation.
Subject(s)
Blood Coagulation Disorders/drug therapy , Digestive System Surgical Procedures/adverse effects , Factor VII/therapeutic use , Gastrointestinal Diseases/surgery , Hemostasis/physiology , Postoperative Hemorrhage/drug therapy , Reoperation/statistics & numerical data , Adult , Aged , Aged, 80 and over , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/etiology , Humans , Middle Aged , Postoperative Hemorrhage/blood , Postoperative Hemorrhage/etiology , Prognosis , Prospective Studies , Recombinant ProteinsABSTRACT
As the final step in breast reconstruction, nipple reconstruction is considered a minor surgical procedure. However, despite the multitude of techniques and postoperative dressings proposed, none have proven to resist the tendency of the reconstructed nipple to gradually flatten over time. A prospective randomized controlled trial was conducted assessing the value of using the Asteame Nipple Guard™ compared to standard gauze dressing in maintaining nipple projection postoperatively. A total of 30 nipple reconstructions in 22 patients were included in the study with randomisation of 15 nipples to each study arm. Nipple projection was measured at various time points postoperatively with calculation of the percent changes in nipple projection. The mean decrease in long-term nipple projection at 6 months in the experimental group was 46.6% vs. 71.8% in the control group (p<0.05). In conclusion, the Nipple Guard™ helps in maintaining nipple projection postoperatively.
