The Experts below are selected from a list of 255 Experts worldwide ranked by ideXlab platform

Okan Erdogan - One of the best experts on this subject based on the ideXlab platform.

Bernard Meunier - One of the best experts on this subject based on the ideXlab platform.

  • Skin Perforator Flap Pedicled by Intercostal Muscle for Repair of a Tracheobronchoesophageal Fistula
    Annals of Thoracic Surgery, 2017
    Co-Authors: Nicolas Bertheuil, Caterina Cusumano, Cécile Meal, Yann Harnoy, Eric Watier, Bernard Meunier
    Abstract:

    A tracheobronchial fistula (TBF) is a rare complication when an operation is performed to treat esophageal carcinoma; no consensus treatment strategy has emerged. We describe a surgical interposition strategy, using a new flap, to repair a TBF that arose when esophageal squamous cell carcinoma was treated with neoadjuvant chemoradiation and minimally invasive esophagectomy (the 3-stage McKeown procedure). We performed a skin perforator flap pedicled by the Intercostal Muscle. It is a valuable option that may be the optimal first-line treatment, especially in the context of neoadjuvant radiation therapy. Furthermore, this strategy affords new options for intrathoracic reconstruction.

Robert J Cerfolio - One of the best experts on this subject based on the ideXlab platform.

  • a nondivided Intercostal Muscle flap further reduces pain of thoracotomy a prospective randomized trial
    The Annals of Thoracic Surgery, 2008
    Co-Authors: Robert J Cerfolio, Ayesha S Bryant, Lee Maniscalco
    Abstract:

    Background The pain of thoracotomy may be related to trauma to the Intercostal nerves. Methods This was a prospective randomized study of 160 patients. All patients had a functioning epidural, similar type and size thoracotomy, an Intercostal Muscle flap (ICM) harvested before rib spreading, inferior rib drilling, and postoperative pain management. In one group, the ICM was left intact distally and it dangled (D group); the ICM in the other was cut distally (C group). Pain was assessed using multiple pain scores. Outcomes assessed were qualitative and quantitative pain scores, number of ribs broken, spirometric values, analgesic use, and return to baseline activity for postoperative days 1 to 5 and weeks 2, 3, 4, 8, and 12. Results The D group had 85 patients and the C group, 75. The groups had similar demographics, types of procedures, and histology. Intrahospital pain scores were similar; however, at postoperative weeks 3, 4, 8, and 12, the D group had significantly lower mean numeric pain scores and was using fewer analgesics ( p p = 0.002). Conclusions An ICM flap reduces pain. Harvesting and then leaving the ICM flap intact instead of cutting it before rib spreading further reduced thoracotomy pain. This technique, when added to rib drilling, leads to reduced pain on postoperative weeks 3 to 12, to quicker return to baseline activity, and lessens the need for analgesics.

  • Intercostal Muscle flap reduces the pain of thoracotomy a prospective randomized trial
    The Journal of Thoracic and Cardiovascular Surgery, 2005
    Co-Authors: Robert J Cerfolio, Ayesha S Bryant, Bhavik N Patel, Alfred A Bartolucci
    Abstract:

    Background Thoracotomy is associated with significant pain and morbidity. Methods We performed a prospective randomized trial over 4 months. Patients were randomized to a standard posterior-lateral thoracotomy or an identical procedure, except an Intercostal Muscle was harvested from the lower rib (to protect the Intercostal nerve) before chest retraction. To ensure an equal distribution among both groups, patients were stratified by race, sex, and type of pulmonary resection. All patients received similar pain management. Pain was assessed by using multiple pain scores during hospitalization and after discharge. Outcomes assessed were pain scores, spirometric values, analgesic use, and activity level. Results There were 114 patients. The median time for Intercostal Muscle harvesting was 3.7 minutes. The numeric pain scores were lower for the Intercostal Muscle group on postoperative days 1 and 2 and at weeks 1, 2, 3, 4, 8, and 12 ( P Conclusions The harvesting of an Intercostal Muscle flap before chest retraction decreases the pain of thoracotomy and leads to a lower decrease in spirometry. In addition, patients have less pain at 1, 2, 3, 4, 8, and 12 weeks postoperatively and are less likely to be using narcotics. Finally, it offers a pedicled Muscle flap that takes little time to harvest and is able to buttress all bronchi after lobectomy.

  • Intercostal Muscle flap to buttress the bronchus at risk and the thoracic esophageal gastric anastomosis
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Robert J Cerfolio, Ayesha S Bryant, Masumi Yamamuro
    Abstract:

    Background We assessed our outcomes using an Intercostal Muscle flap harvested with cautery prior to chest retraction. Methods Our retrospective study was conducted using an electronic prospective database. Results There were 456 patients (348 men) over a six year period. The Intercostal Muscle flap was used for bronchial coverage in 391 patients. The indications for the flap were neoadjuvant radiochemotherapy in 285 patients, infection or inflammatory disease in 106, to buttress an esophageal-gastric anastomosis in 49, and for esophageal fistula in 16. There were three bronchopleural fistulas (0.7%); one after a right pneumonectomy for tuberculosis, one after a left pneumonectomy, and one after a lobectomy in a heart transplant patient for mucormycosis. The 4-week median postoperative pain score for patients who underwent an Intercostal Muscle flap was lower compared with historic controls who underwent similar procedures over the same time frame but did not have an Intercostal Muscle flap (2.4 vs 3.7, p = 0.003). Follow-up was a median of 26 months (range, 1 to 72 months) and no patients had ossification of their flap. Conclusions An Intercostal Muscle flap is a versatile pedicle flap that can reach all bronchi. It is easy to harvest, adds no morbidity, and may protect the bronchi at risk. When harvested devoid of periosteum it does not ossify over time and it may reduce the pain of thoracotomy.

Paul W Davenport - One of the best experts on this subject based on the ideXlab platform.

  • The transduction properties of Intercostal Muscle mechanoreceptors
    BMC Physiology, 2002
    Co-Authors: Gregory A Holt, Richard D Johnson, Paul W Davenport
    Abstract:

    Background Intercostal Muscles are richly innervated by mechanoreceptors. In vivo studies of cat Intercostal Muscle have shown that there are 3 populations of Intercostal Muscle mechanoreceptors: primary Muscle spindles (1°), secondary Muscle spindles (2°) and Golgi tendon organs (GTO). The purpose of this study was to determine the mechanical transduction properties of Intercostal Muscle mechanoreceptors in response to controlled length and velocity displacements of the Intercostal space. Mechanoreceptors, recorded from dorsal root fibers, were localized within an isolated Intercostal Muscle space (ICS). Changes in ICS displacement and the velocity of ICS displacement were independently controlled with an electromagnetic motor. ICS velocity (0.5 – 100 μm/msec to a displacement of 2,000 μm) and displacement (50–2,000 μm at a constant velocity of 10 μm/msec) parameters encompassed the full range of rib motion. Results Both 1° and 2° Muscle spindles were found evenly distributed within the ICS. GTOs were localized along the rib borders. The 1° spindles had the greatest discharge frequency in response to displacement amplitude followed by the 2° afferents and GTOs. The 1° Muscle spindles also possessed the greatest discharge frequency in response to graded velocity changes, 3.0 spikes·sec^-1/μm·msec^-1. GTOs had a velocity response of 2.4 spikes·sec^-1/μm·msec^-1 followed by 2° Muscle spindles at 0.6 spikes·sec^-1/μm·msec^-1. Conclusion The results of this study provide a systematic description of the mechanosenitivity of the 3 types of Intercostal Muscle mechanoreceptors. These mechanoreceptors have discharge properties that transduce the magnitude and velocity of Intercostal Muscle length.

  • The transduction properties of Intercostal Muscle mechanoreceptors.
    BMC Physiology, 2002
    Co-Authors: Gregory A Holt, Richard D Johnson, Paul W Davenport
    Abstract:

    Intercostal Muscles are richly innervated by mechanoreceptors. In vivo studies of cat Intercostal Muscle have shown that there are 3 populations of Intercostal Muscle mechanoreceptors: primary Muscle spindles (1°), secondary Muscle spindles (2°) and Golgi tendon organs (GTO). The purpose of this study was to determine the mechanical transduction properties of Intercostal Muscle mechanoreceptors in response to controlled length and velocity displacements of the Intercostal space. Mechanoreceptors, recorded from dorsal root fibers, were localized within an isolated Intercostal Muscle space (ICS). Changes in ICS displacement and the velocity of ICS displacement were independently controlled with an electromagnetic motor. ICS velocity (0.5 – 100 μm/msec to a displacement of 2,000 μm) and displacement (50–2,000 μm at a constant velocity of 10 μm/msec) parameters encompassed the full range of rib motion. Both 1° and 2° Muscle spindles were found evenly distributed within the ICS. GTOs were localized along the rib borders. The 1° spindles had the greatest discharge frequency in response to displacement amplitude followed by the 2° afferents and GTOs. The 1° Muscle spindles also possessed the greatest discharge frequency in response to graded velocity changes, 3.0 spikes·sec-1/μm·msec-1. GTOs had a velocity response of 2.4 spikes·sec-1/μm·msec-1 followed by 2° Muscle spindles at 0.6 spikes·sec-1/μm·msec-1. The results of this study provide a systematic description of the mechanosenitivity of the 3 types of Intercostal Muscle mechanoreceptors. These mechanoreceptors have discharge properties that transduce the magnitude and velocity of Intercostal Muscle length.

  • Cerebral cortical evoked potentials elicited by cat Intercostal Muscle mechanoreceptors.
    Journal of applied physiology (Bethesda Md. : 1985), 1993
    Co-Authors: Paul W Davenport, Roger Shannon, A.r. Mercak, Roger L. Reep, Bruce G. Lindsey
    Abstract:

    Intercostal Muscle afferents discharge in response to changes in Intercostal Muscle mechanics and have spinal and brain stem projections. It was hypothesized that Intercostal Muscle mechanoreceptors also project to the sensorimotor cortex. In cats, the proximal Muscle branch of an Intercostal nerve was used for electrical stimulation. The mechanical stimulation was stretch of an isolated Intercostal space. The sensorimotor cortex was mapped with a surface ball electrode. Primary cortical evoked potentials (CEP) were found in area 3a of the sensorimotor cortex with mechanical and electrical stimulation. The CEP was elicited with the smallest stretch amplitude used, 50 microns. The CEP response showed little increase beyond 300-microns stretch. The CEP elicited by 50-microns stretch suggests an initial cortical activation by Intercostal Muscle spindles. The minimal increase in CEP amplitude with stretch > 300 microns suggests that the CEP response is primarily due to Muscle spindle recruitment. The increase in amplitude beyond this stretch may be due to recruitment of tendon organs. These results demonstrate a short-latency projection of Intercostal Muscle mechanoreceptors to the sensorimotor region of the cerebral cortex. This cortical activation may be involved in respiratory sensations and/or transcortical reflex responses to changes in respiratory Muscle mechanics.

Tsutomu Sakuma - One of the best experts on this subject based on the ideXlab platform.

  • Video-Assisted Bronchial Stump Reinforcement With an Intercostal Muscle Flap
    The Annals of thoracic surgery, 2004
    Co-Authors: Motoyasu Sagawa, Makoto Sugita, Yuji Takeda, Hirohisa Toga, Tsutomu Sakuma
    Abstract:

    For lobectomy patients at considerable risk of developing a postoperative bronchopleural fistula, the bronchial stump reinforcement with an Intercostal Muscle flap is sometimes performed. This procedure usually requires a standard thoracotomy, even if video-assisted thoracoscopic surgery (VATS) is better for the patient. Our patient was a 76-year-old male with lung cancer and severe diabetes mellitus. He underwent lobectomy and systematic nodal dissection combined with bronchial stump reinforcement using an Intercostal Muscle flap, performed as a VATS procedure. No postoperative complications were observed. This procedure is applicable to patients who are candidates for VATS lobectomy.