A modified technique of percutaneous subclavian venous catheterization in the oedematous burned patient.

Infraclavicular subclavian venepuncture in the oedematous burned patient is often difficult because of increased depth of the vein. In addition, proper patient positioning is not easily achieved because of extensive burns, generalised oedema and bulky dressings. To overcome these difficulties, a modified technique of infraclavicular subclavian venepuncture has been developed. The introducer needle is bent to create a mild curvature. It is inserted at a point 1-2 cm inferior to the palpable lower border of the clavicle along the junction of the middle and medial thirds of the bone, advanced along the deep surface of the clavicle and directed at the superior border of the suprasternal notch. This medial point of insertion shortens the distance of access to the subclavian vein. The curve allows the tip to be kept close to the undersurface of the clavicle as the needle is advanced, thereby reducing the risk of injury to deep structures. The advantages of the modified technique are demonstrated in anatomical dissections. This technique is a viable alternative when conventional techniques fail.

An anthropometric analysis of indices of severity in the unilateral cleft lip.

The aim of this study was to analyze the relationships among three key anthropometric parameters in the unilateral cleft lip to determine the correlations, if any, among these indices of severity. Using a standardized anthropometric documentation protocol, preoperative measurements of 125 unilateral cleft lips (103 complete and 22 incomplete) were performed under general anesthesia by a single surgeon at the time of primary lip repair at the age of 3 months. The following key measurements were analyzed statistically: (1) the philtral height difference (PHD) between the cleft and noncleft sides, (2) the nasal floor width difference (NFWD) between the cleft and noncleft sides, and (3) the cleft width (CW). The mean values of all three indices were greater in the complete group versus the incomplete group. These differences were statistically significant. Linear relationships were obtained between NFWD and GAP, between PHD and GAP, and between PHD and NFWD in the complete group. In contrast, the relationships between PHD and GAP, and between PHD and NFWD were nonlinear in the incomplete group. These findings suggest that there was a strong correlation between the transverse and vertical tissue deficiencies in the complete cleft lip. In incomplete clefts, however, this correlation did not exist. In other words, the incomplete cleft lip can be associated with a severely short philtrum even in the presence of a relatively mild transverse tissue deficit. Therefore, it is not necessarily easier to repair an incomplete cleft lip in terms of the correction of the vertical tissue deficiency.