Browsing Galway University Hospitals by Subjects
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Maxillofacial osseous reconstruction using the angular branch of the thoracodorsal vessels.Mandibular and maxillary resections can produce complex three-dimensional defects requiring skeletal, soft tissue, and epithelial reconstruction. The subscapular vascular axis offers a source of skin, bone, and muscle on a single pedicle for microvascular flap transfer. We reviewed four cases where the subscapular vascular pedicle was used as a source of tissue for complex facial reconstructions in maxillofacial defects. Reconstruction of these complex defects was performed with a latissimus dorsi muscle or myocutaneous flap in combination with the lateral border of the scapula, harvested on the angular branch of the thoracodorsal vessels. There were three cases of maxillectomy and one case of partial mandibulectomy for malignant tumors. In each case, the angular branch of the thoracodorsal artery supplied 6 to 8 cm of the lateral border of the scapula and a latissimus dorsi myocutaneous flap was used for soft tissue reconstruction. Follow-up ranged from 9 months to 3 years and in all cases there was successful bony union. Shoulder movement was normal. This series encourages the further use of subscapular axis flaps as flexible sources of combined myocutaneous and osseous flaps on a single vascular pedicle in cases of complex maxillofacial reconstruction.
Optimal patient positioning for ligamentotaxis during balloon kyphoplasty of the thoracolumbar and lumbar spine.Percutaneous balloon kyphoplasty aims to restore vertebral height, correct angular deformity and stabilize the spine in the setting of vertebral compression fractures. The patient is positioned prone with supports under the iliac crests and upper thorax to allow gravity to extend the spine. In the treatment of lumbar fractures, we evaluated patient positioning with the contribution of hip extension to increase anterior ligamentotaxis, thus facilitating restoration of vertebral height. Our positioning technique created a mean anterior height increase from 72% to 78% of the average height of the cranial and caudal vertebrae (p=0.037). Balloon inflation did not significantly further increase anterior or posterior vertebral height, or Cobb angle.
Transversus abdominis plane block: a cadaveric and radiological evaluation.The abdominal wall is a significant source of pain after abdominal surgery. Anterior abdominal wall analgesia may assist in improving postoperative analgesia. We have recently described a novel approach to block the abdominal wall neural afferents via the bilateral lumbar triangles of Petit, which we have termed a transversus abdominis plane block. The clinical efficacy of the transversus abdominis plane block has recently been demonstrated in a randomized controlled clinical trial of adults undergoing abdominal surgery.