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McKissack H, McLynn R, Pitts C, Alexander B, Jones J, Andrews NA, Littlefield ZL, Shah A. Safety and Efficacy of Achilles Repair Using the Mini-Open Approach in Supine Versus Prone Position: A Retrospective Study. Cureus 2021; 13:e17564. [PMID: 34646620 PMCID: PMC8480360 DOI: 10.7759/cureus.17564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Surgical repair of the Achilles tendon is a common procedure in cases of acute rupture. Open Achilles tendon surgery with a traditional extensile approach is most often performed in the prone position, but this can lead to numerous complications. The mini-open approach for repair in the supine position may avoid the risks of the prone position. The purpose of this study is to compare perioperative outcomes and differences in cost between patients undergoing acute Achilles rupture repair with mini-open approach, incision of approximately 3 cm, in the supine position versus traditional approach in the prone position. Methods Patients who underwent surgical repair of acute Achilles rupture at a single institution were retrospectively identified using Current Procedural Terminology (CPT) code 27650. Complication rates and the total cost charged to the insurance companies of both the supine and prone groups were calculated. Results A total of 80 patients were included for analysis, 26 supine and 54 prone. The difference in average total time in the operating room was statistically significant. The prone position took approximately 15% more time (118.7 minutes) compared to the supine position (100 minutes) (p = 0.001). While not statistically significant, the total cost for the supine group ($19,889) was less than the for the prone group ($21,722) (p = 0.153) Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and deep vein thrombosis (DVT) rate were also similar between the two groups. No patient in either group experienced re-rupture of the Achilles tendon within the first year of primary repair. Conclusion The mini-open approach in the supine position may be advantageous in the repair of acute Achilles rupture in that it reduces total time in the operating room and total cost while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.
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Affiliation(s)
- Haley McKissack
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ryan McLynn
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Charles Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Bradley Alexander
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - James Jones
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Zachary L Littlefield
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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Saiwai H, Okada S, Kawaguchi KI, Saito T, Hayashida M, Matsushita A, Matsumoto Y, Nakashima Y. Prone position surgery for a professional sumo wrestler with thoracic ossification of the posterior longitudinal ligament resulting in intraoperative brachial plexus injury by hypertrophic pectoral muscles. J Clin Neurosci 2019; 63:227-230. [PMID: 30777366 DOI: 10.1016/j.jocn.2019.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
Surgery in the prone position is associated with a variety of complications due to the positioning, including the widely recognized peripheral nerve compression injuries and brachial plexus neuropathy. Previous studies have reported that thin body habitus is a predisposing risk factor for the compressive peripheral nerve injuries due to the prone position surgery. However, prone-position-related brachial plexus injury in patients who are overweight due to hypertrophic muscles have never been reported. Here we report a case of a professional sumo wrestler with severe thoracic ossification of the posterior longitudinal ligament (OPLL). Thoracic OPLL was successfully treated by posterior spinal fusion and decompression surgery. Despite a preoperative simulation and intraoperative inspection of the patient's surgical positioning, he suffered from bilateral upper extremity paralysis immediately after the surgery. Postoperative axillary MRI image revealed a high-intensity area on both sides of his pectoral muscles and axillary fossa, which implied that the pectoral muscles between the ribs and chest pad were pushed out toward the axillary fossa, resulting in compressive brachial plexus injury. His upper extremity motor paralysis was fully recovered in 6 months, but he still has mild tingling sensation even after 12 months of his surgery. In conclusion, overweight patients with hypertrophic muscles pose a risk for brachial plexus entrapment injury by pectoral muscles during prone-position surgery, and therefore it would be more effective to use a wide chest pad to reduce the pressure on the pectoral muscles to prevent it from being pushed out toward the axillary fossa.
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Affiliation(s)
- Hirokazu Saiwai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan; Department of Immunobiology and Neuroscience, Medical Institute of Bioregulation, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ken-Ichi Kawaguchi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takeyuki Saito
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Mitsumasa Hayashida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Akinobu Matsushita
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
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3
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Abstract
Supplemental Digital Content is available in the text.
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Minas V, Aust T. Idiopathic brachial plexus neuritis after laparoscopic treatment of endometriosis: a complication that may mimic position-related brachial plexus injury. J Minim Invasive Gynecol 2013; 20:891-3. [PMID: 24183278 DOI: 10.1016/j.jmig.2013.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/28/2022]
Abstract
We report the case of a 37-year-old woman who developed idiopathic brachial plexus neuritis, also referred to as Parsonage-Turner syndrome, after laparoscopic excision of endometriosis. The differential diagnosis between this non-position-related neuritis and brachial plexus injury is discussed. The aim of this report was to raise awareness on this distressing postoperative complication.
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Affiliation(s)
- Vasileios Minas
- Endometriosis Centre, Department of Obstetrics and Gynaecology, Wirral University Teaching Hospital, Upton, United Kingdom (both authors).
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5
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Abstract
Parsonage-Turner Syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder consisting of a complex constellation of symptoms with abrupt onset of shoulder pain, usually unilaterally, followed by progressive neurologic deficits of motor weakness, dysesthesias, and numbness. Although the etiology of the syndrome is unclear, it is reported in various clinical situations, including postoperatively, postinfectious, posttraumatic, and postvaccination. The identification of the syndrome in the postoperative patient remains a challenge as symptoms may easily be attributed to sequelae of surgical positioning, postoperative recovery, or postanesthetic block pain. The purpose of this review is to bring forth salient, identifiable factors which may assist the surgical clinician in identifying the condition sooner. An early and proper diagnosis affords the opportunity to treat the patient accordingly and to the satisfaction of both surgeon and patient.
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Affiliation(s)
- Joseph H. Feinberg
- Physiatry Department, Hospital for Special Surgery, 523 East 72nd Street, 2nd Floor, New York, NY 10021 USA
| | - Jeffrey Radecki
- Weill Cornell Medical College, 525 E 68th St., Box 142, New York, NY 10065 USA
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Wenk M, Pöpping D, Henning M, Wenk M, Liljenqvist U, Möllmann M. Creation of a head and face protection device for children undergoing procedures in prone position. Paediatr Anaesth 2009; 19:587-92. [PMID: 19645977 DOI: 10.1111/j.1460-9592.2009.03008.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Positioning the head of patients undergoing procedures in lateral or prone position remains a difficult task for the anesthesiologists. Associated risks have attracted increasing attention because they range from minor facial soft tissue injuries to catastrophic complications such as stroke or postoperative blindness. Earlier, we reported on the use of a boxing sports helmet for simple and easy positioning of the head. However, as available helmets are limited in sizes and materials, that system is not easily transferable to children. Therefore, we sought to create a face and head protection device for children undergoing procedures in prone position. METHODS/MATERIALS We re-engineered a standard boxing sports helmet making it suitable as an on-head support cushion. By using WHO standard growth charts, various sizes were calculated and prototypes of different foam materials produced. Facial surface pressures were measured in 15 volunteers. RESULTS A lightweight foam-based face mask was created. Minimum necessary foam thickness was 2.5 cm. Different materials were tested and pressure in different facial zones never exceeded 30 mmHg. CONCLUSION Bringing a face protection device onto the patient's face instead of placing the face into support cushions is an elegant way of keeping control over airway devices and providing support for facial structures in various positions simultaneously. Skin surface pressure on facial structures remained low due to the specific mask design and choice of foam materials, which could lead to decreased incidences of undesired sequelae of prone position such as skin damage or even more devastating complications.
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Affiliation(s)
- Manuel Wenk
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Münster, Germany.
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Abstract
Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. We have reviewed the development of the prone position and its variants and the physiological changes which occur on prone positioning. The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.
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Affiliation(s)
- H Edgcombe
- Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK
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Möllmann M, Henning M, Liljenqvist U, Wenk M. A foam-cushion face mask and a see-through operation table: a new set-up for face protection and increased safety in prone position. Br J Anaesth 2007; 99:597-8. [PMID: 17827190 DOI: 10.1093/bja/aem248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, Astobieta A, Camargo I, Gamarra M, Tempia A, Valdivia Uria JG, Scarpa RM. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007; 100:233-6. [PMID: 17552975 DOI: 10.1111/j.1464-410x.2007.06960.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gaspar Ibarluzea
- Department of Urology, Galdakao Hospital, Bizkaia, Basque Country, Spain
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Huang YC, Wang HC, Tsai YF, Chang SF, Hsu WC. Postsurgical brachial neuritis after orthognathic surgery: a case report. J Oral Maxillofac Surg 2005; 63:1387-90. [PMID: 16122609 DOI: 10.1016/j.joms.2005.05.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yung-Chuan Huang
- Department of Neurology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan
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Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. ACTA ACUST UNITED AC 2005; 63:5-18; discussion 18. [PMID: 15639509 DOI: 10.1016/j.surneu.2004.03.024] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 03/15/2004] [Indexed: 11/21/2022]
Abstract
Intraoperative positioning nerve injuries are regrettable complications of surgery thought to arise from stretch and/or compression of vulnerable peripheral nerves. Generally thought to be preventable, these injuries still occur in patients despite rigorous preventative measures. Sometimes injuries, initially thought to be due to malpositioning, are caused by other factors, such as retraction injury or brachial plexitis. Because of the diversity of nerves susceptible to positioning injury, the clinician must be aware of a variety of presentations and must be able to distinguish them from other postoperative complaints. Prevention remains the mainstay of the management of positioning injuries. Diagnosed and managed appropriately, these lesions typically improve completely over time.
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Affiliation(s)
- Christopher J Winfree
- Department of Neurological Surgery, The Neurological Institute, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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12
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Blunt LW, Rubenstein JN, Matschke M, Gonzalez CM. Prone positioning for bulbar urethral reconstruction. Urology 2003; 61:224. [PMID: 12559310 DOI: 10.1016/s0090-4295(02)02094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exaggerated lithotomy is a surgical position associated with significant morbidity. We describe the use of the prone position for bulbar urethral reconstruction in a selected patient. We propose modified prone positioning as an alternative to exaggerated lithotomy for select patients undergoing reconstruction of the bulbar urethra.
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Affiliation(s)
- Lynn W Blunt
- Department of Urology, Northwestern University Medical School, Chicago, Illinois, USA
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13
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Schwartz DM, Drummond DS, Hahn M, Ecker ML, Dormans JP. Prevention of positional brachial plexopathy during surgical correction of scoliosis. JOURNAL OF SPINAL DISORDERS 2000; 13:178-82. [PMID: 10780696 DOI: 10.1097/00002517-200004000-00015] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Continuous intraoperative monitoring of spinal cord function using somatosensory evoked potentials (SSEP) has gained nearly universal acceptance as a reliable and sensitive method for detecting and possibly preventing neurologic injury during surgical correction of spinal deformities. In several reports, spinal cord injury was identified successfully based on changes in SSEP response characteristics, specifically amplitude and latency. Less well documented and used, however, is monitoring of peripheral nerve function with SSEPs to identify and prevent the neurologic sequelae of prolonged prone positioning on a spinal frame. The authors describe a patient who underwent surgical removal of spinal instrumentation but was not monitored. A brachial plexopathy developed in this patient from pressure on the axilla exerted by a Relton-Hall positioning frame during spinal surgery. In addition, data are presented from 15 of 500 consecutive pediatric patients who underwent surgical correction of scoliosis between 1993 and 1997 with whom intermittent monitoring of ulnar nerve SSEPs was used successfully to identify impending brachial plexopathy, a complication of prone positioning. A statistically significant reduction in ulnar nerve SSEP amplitude was observed in 18 limbs of the 500 patients (3.6%) reviewed. Repositioning the arm(s) or shoulders resulted in nearly immediate improvement of SSEP amplitude, and all awoke without signs of brachial plexopathy. This complication can be avoided by monitoring SSEPs to ulnar nerve stimulation for patients placed in the prone position during spinal surgery.
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Affiliation(s)
- D M Schwartz
- Surgical Monitoring Associates, Bala Cynwyd, Pennsylvania 19004, USA
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14
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Thoracic Disc. J Neurosurg 1996. [DOI: 10.3171/jns.1996.85.1.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Thoracic Disc. J Neurosurg 1996. [DOI: 10.3171/jns.1996.85.1.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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