The Experts below are selected from a list of 492 Experts worldwide ranked by ideXlab platform
Mark K. Wax - One of the best experts on this subject based on the ideXlab platform.
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Novel STSG Donor Site for ForeArm Flaps: Radial Skin Paddle
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Tamer A. Ghanem, Mark K. WaxAbstract:ObjectiveSplit thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial foreArm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial.MethodsProspective data was collected from patients undergoing foreArm free flap reconstruction at a tertiary medical center in a 6-month period. The radial foreArm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after Arm Tourniquet activation.ResultsThere were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean foreArm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non-meshed. Harvesting from the fore...
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Novel STSG Donor Site for ForeArm Flaps: Radial Skin Paddle
Otolaryngology–Head and Neck Surgery, 2008Co-Authors: Tamer A. Ghanem, Mark K. WaxAbstract:Objective Split thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial foreArm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial. Methods Prospective data was collected from patients undergoing foreArm free flap reconstruction at a tertiary medical center in a 6-month period. The radial foreArm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after Arm Tourniquet activation. Results There were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean foreArm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non-meshed. Harvesting from the foreArm skin paddle was successful in 25 patients (93%). Two patients required a thigh STSG; both patients were octagenerians with frail skin. All the foreArm donor sites healed well, except one patient required a later revision procedure for exposed tendon. Conclusions Based on this study, the thigh STSG donor site can be eliminated in 9 out of 10 patients undergoing radial foreArm free flaps. This translates to decreased risk of pain, infection, and wound oozing. Older patients with frail skin and atrophied foreArm muscles were likely to require a thigh donor site.
Tamer A. Ghanem - One of the best experts on this subject based on the ideXlab platform.
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Novel STSG Donor Site for ForeArm Flaps: Radial Skin Paddle
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Tamer A. Ghanem, Mark K. WaxAbstract:ObjectiveSplit thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial foreArm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial.MethodsProspective data was collected from patients undergoing foreArm free flap reconstruction at a tertiary medical center in a 6-month period. The radial foreArm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after Arm Tourniquet activation.ResultsThere were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean foreArm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non-meshed. Harvesting from the fore...
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Novel STSG Donor Site for ForeArm Flaps: Radial Skin Paddle
Otolaryngology–Head and Neck Surgery, 2008Co-Authors: Tamer A. Ghanem, Mark K. WaxAbstract:Objective Split thickness skin grafts (STSG) harvested from the thigh are often utilized to provide coverage for radial foreArm donor sites. To eliminate the morbidity of the thigh STSG donor site, we assessed the feasibility of harvesting the STSG from the radial. Methods Prospective data was collected from patients undergoing foreArm free flap reconstruction at a tertiary medical center in a 6-month period. The radial foreArm free flap (RFFF) harvesting procedure was modified to incorporate STSG harvest from the paddle site as the first step after Arm Tourniquet activation. Results There were 27 patients in this cohort, with mean age of 68.2. There were 24 fasciocutaneous RFFF, 2 osteocutaneous RFFF, and 1 ulnar flap. The indications for free tissue transfer were as follows: intraoral defects (n=13), pharyngeal patch repair (n=8), total laryngopharyngectomy (n=1), external skin coverage (n=5). The mean foreArm defect was 41.2 cm2 (24–77 cm2). 22 out of 27 skin grafts were non-meshed. Harvesting from the foreArm skin paddle was successful in 25 patients (93%). Two patients required a thigh STSG; both patients were octagenerians with frail skin. All the foreArm donor sites healed well, except one patient required a later revision procedure for exposed tendon. Conclusions Based on this study, the thigh STSG donor site can be eliminated in 9 out of 10 patients undergoing radial foreArm free flaps. This translates to decreased risk of pain, infection, and wound oozing. Older patients with frail skin and atrophied foreArm muscles were likely to require a thigh donor site.
Stephen Lipscombe - One of the best experts on this subject based on the ideXlab platform.
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pain and outcomes of carpal tunnel release under local anaesthetic with or without a Tourniquet a randomized controlled trial
Journal of Hand Surgery (European Volume), 2018Co-Authors: Hafiz Javaid Iqbal, Ashtin Doorgakant, Nader N T Rehmatullah, Ashok L Ramavath, Prasad Pidikiti, Stephen LipscombeAbstract:We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an Arm Tourniquet and 36 without Tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a Tourniquet experienced a significantly greater degree of pain when compared with those who did not have a Tourniquet. Pain and hand function improved to a similar degree in both groups. We conclude that carpal tunnel decompression performed with a Tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a Tourniquet.Level of evidence: I
S. Johnson - One of the best experts on this subject based on the ideXlab platform.
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Tourniquet POSITION FOR CARPAL TUNNEL DECOMPRESSION: Arm VERSUS FOREArm
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: G.r. Cousins, P.k. Rickhuss, C. Tinning, S. Gill, S. JohnsonAbstract:Pain produced by the Tourniquet is a common source of complaint for patients undergoing carpal tunnel decompression. Practice varies as to Tourniquet position. There is little evidence to suggest benefit of one position over another. Our aim was to compare the experience of both the patient and the surgeon with the Tourniquet placed either on the Arm or the foreArm. Ethical approval was granted. Following power calculation and a significance level set at 0.05, 100 patients undergoing open carpal tunnel decompression under local anaesthetic were randomised to Arm or foreArm group. Visual Analogue Scores (VAS) (0–100) for pain, blood pressure and heart rate were taken at 2 minute intervals. The operating surgeon provided a VAS for bloodless field achieved and obstruction caused by the Tourniquet. The demographics of the groups was similar. There were no statistically significant differences in any measure between the groups. Average Tourniquet times were 8.8 minutes (foreArm) and 8.2 minutes (Arm). The average VAS score for foreArm and Arm was 13 and 11 respectively for bloodless field, 9 and 2 for obstruction. Average overall VAS for pain was 27 in each group, however interval VAS scores for pain were higher in the Arm group. The average change Mean Arterial Pressure was −5 mmHg (foreArm) −2 mmHg (Arm) pulse rate was −1 bpm (foreArm) and −2 bpm (Arm). Tourniquet placement on the Arm does not result in significant difference in patient pain, physiological response or length of operation. Surgeons reported less obstruction and better bloodless fields with an Arm Tourniquet, however there was a trend for foreArm Tourniquet to result in less pain for the patient.
Poornachandran Manikantan - One of the best experts on this subject based on the ideXlab platform.
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an evaluation of the analgesic efficacy of intravenous regional anesthesia with lidocaine and ketorolac using a foreArm versus upper Arm Tourniquet
Anesthesia & Analgesia, 2002Co-Authors: Scott S Reuben, Robert B Steinberg, Holly Maciolek, Poornachandran ManikantanAbstract:UNLABELLED: Intravenous regional anesthesia (IVRA) using a foreArm Tourniquet may be a potentially safer technique compared with using an upper Arm Tourniquet. Ketorolac is a useful adjuvant to lidocaine for IVRA. In this study, we assessed the analgesic efficacy of administering IVRA lidocaine and ketorolac with either a foreArm or upper Arm Tourniquet for outpatient hand surgery. Upper Arm IVRA was established using 40 mL of a solution containing 200 mg of lidocaine and ketorolac 20 mg (0.5 mg/mL). ForeArm IVRA was established using 20 mL of a solution containing 100 mg of lidocaine and ketorolac 10 mg (0.5 mg/mL). Onset and duration of sensory block as well as postoperative pain and analgesic use were recorded. The patients who received foreArm IVRA had a significantly longer period during which they required no analgesics (701 +/- 133 min) compared with 624 +/- 80 min for the upper Arm IVRA ketorolac patients (P = 0.032). Onset of sensory block was similar between the two groups; however, recovery of sensation was significantly longer in the ForeArm IVRA (22 +/- 5 min) group compared with the Upper Arm IVRA (13 +/- 3 min) group (P < 0.05). There were no differences in postoperative analgesic use or pain scores between the two groups. We conclude that foreArm IVRA with lidocaine and ketorolac provides safe and effective perioperative analgesia for patients undergoing ambulatory hand surgery. This technique results in a longer duration of sensory block and prolonged postoperative analgesia compared with upper Arm IVRA while using one-half the doses of both lidocaine and ketorolac. IMPLICATIONS: ForeArm Tourniquet intravenous regional anesthesia (IVRA) with 50% less lidocaine and ketorolac provides for both a longer duration of sensory block and prolonged postoperative analgesia compared with upper Arm IVRA.