Safety of locating the tip of a medium-long catheter at the axillary front and clavicle midline: A protocol for systematic review and meta-analysis

BACKGROUND

Medium-long catheters are being used more and more widely in clinical practice, but we still do not know the impact of different placements, but this is an important clinical issue that cannot be ignored.

OBJECTIVE

At present, the tip positioning of the mid-length catheter mainly includes the anterior part of the axilla and the midclavicular line. Different positioning may have different effects. Therefore, we did this research to confirm which positioning is more safety.

METHODS

We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, China Knowledge Network, China Biomedical Literature Database, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by 2 researchers, and finally, use Stata to carry out meta-analysis.

RESULTS

This study is ongoing and the results will be submitted to a peer-reviewed journal for publication.

ETHICS AND DISSEMINATION

Ethical approval is not applicable, since this is an overview based on published articles.

PROTOCOL REGISTRATION NUMBER

INPLASY2020110042.

Morphometric analyses of clavicle's nutrient foramen

PURPOSE

Fractures of the clavicle, which has an important location and function in the upper extremity and shoulder joint, compose 10% of all fracture cases. During the osteosynthesis of clavicle fractures and in the post-operative period of patients, considering the detailed morphometric and topographic properties of the nutrient foramen of clavicle is important to avoid the disruption of arterial nutrition of the clavicle and prevent unexpected injuries. The aim of this study was to investigate the morphometric properties of the nutrient foramen of clavicle in more detail using computedtomography images.

METHODS

Computed tomography images of 116 healthy individuals (56 women/60 men) who had no pathology history were included in the presented study. Computed tomography images were reconstructed three-dimensionally using free-licensed Horos v3.3.3 software. Then, distances from clavicle's nutrient foramen to sternal end, anterior and posterior edges of the clavicle were measured. Statistical analyses were completed using SPSS v21 software.

RESULTS

Our results demonstrated that the nutrient foramen of clavicle was located closer to the sternal end of the clavicle. The shortest distance to the sternal edge of clavicle was measured as 3.3 cm. Analyses of gender differences indicated that statistically significant differences were in favor of men. However, topographic properties of the clavicle's nutrient foramen were not affected by age.

CONCLUSION

Nutrient foramen is mostly located closer to the sternal end of clavicle. Especially during osteosynthesis of clavicle fractures at the sternal end, maintaining the arterial supply of clavicle is of great importance for increasing the post-operative life quality of patients.

Successful management of the supraclavicular artery island flap combined with a sternohyoid muscle flap for hypopharyngeal and laryngeal reconstruction

This retrospective study evaluated operative outcomes when using a supraclavicular artery island flap (SAIF) combined with a sternohyoid muscle flap (SHMF) to reconstruct defects after hypopharyngeal carcinoma resection. Reconstructive surgery for hypopharyngeal and laryngeal defects was performed with the SAIF + SHME combination in 6 patients during 2016 to 2018. Within 14 to 16 days after the surgery, all 6 patients could ingest food and block the tube (avoiding aspiration), with no pharyngeal fistulas. They then underwent irradiation up to a total of 60.5 Gy during the 4 weeks postoperatively. All 6 flaps survived, and there were no donor-site complications except minor dehiscence in 1 patient. Thus, the SAIF + SHMF combination can be used to reconstruct hypopharyngeal and laryngeal defects after hemi-laryngectomy in patients with hypopharyngeal carcinoma involving the unilateral larynx. This technique effectively preserved the swallowing function and phonation of the patients, thereby improving their quality of life.

The distributed pattern of the neurovascular structures around clavicle to minimize structural injury in clinical field: anatomical study

INTRODUCTION

The aim of this study was to determine the location and distribution pattern of neurovascular structures superior and inferior to the clavicle by detailed dissection.

METHODS

Fifteen adult non-embalmed cadavers with a mean age of 71.5 years were studied. For measurements, the most prominent point of the sternal end of the clavicle (SEC) on anterior view and the most prominent point of the acromial end of the clavicle (AEC) were identified and divided five equal sections before dissection. A line connecting the SEC and AEC was used as a reference line. The surrounding neurovascular structures were investigated.

RESULTS

The supraclavicular nerve was mainly distributed in the second and the third sections (distribution frequency: 41.30% and 30.43%, respectively) from AEC. Branches of the thoracoacromial artery were mainly distributed in the second, third, and fourth sections (distribution frequency: 21.15%, 26.92%, and 28.85%, respectively). Branches of the subclavian vein were mainly distributed in the third and fourth sections (distribution frequency: 23.26 and 30.23%, respectively). Distribution frequency of subclavian vein, subclavian artery, and brachial plexus ranged from 31.3 to 57.5%.

DISCUSSION

When the clavicle was divided into five sections, there was relatively little distribution of neurovascular damage in the first section or the fifth section. This study reveals the average location of subclavian vein with artery and brachial plexus. Results of this study could be used as reference during surgery.

Arteriolymphatic Fistula: An Unusual Cause of Spontaneous Swelling in the Left Supraclavicular Region

An abnormal fistulous communication between an artery and lymphatic system is a rare occurrence. We report a 38-year-old male presenting with sudden onset, spontaneous, pulsatile swelling in the left supraclavicular region following a recent cardiac catheterisation via right femoral arterial access. On evaluation, he was found to have a femoral arteriolymphatic fistula. He was managed conservatively with ultrasound-guided compression with complete resolution of symptoms at follow-up. This case describes a hitherto unknown complication of percutaneous vascular cannulation presenting in an unusual manner, diagnosed with Doppler Ultrasonography and CT angiography and managed effectively with a non-invasive therapeutic image-guided manoeuvre.

Three superficial veins coursing over the clavicles: a case report

We report a unique bilateral combination of multiple variations in the superficial venous system of the neck of a 77-year-old male cadaver. On the right side of the neck, the external jugular vein (EJV) crossed superficial to the lateral third of the clavicle constituting a common trunk with the cephalic vein (CV) that drained into the subclavian vein (SCV). On the left side the EJV descended distally, passed over the anterior surface of the medial third of the clavicle and drained into the SCV. The posterior external jugular vein (PEJV) crossed superficial to the lateral third of the clavicle and terminated into the CV, providing an additional communicating branch to the EJV. Knowledge of both normal and abnormal anatomy of the veins of the neck plays an important role for anesthesiologists or cardiologists doing catheterization, orthopedic surgeons treating clavicle fractures and general surgeons performing head and neck surgery, to avoid inadvertent injury to these vascular structures.

Repair of skin covering osteoradionecrosis of the mandible with the fasciocutaneous supraclavicular artery island flap: case report

INTRODUCTION

Osteoradionecrosis of the mandible is a serious complication following radiotherapy for head and neck cancer. Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly myocutaneous flaps and skin grafts to free microsurgical flaps to ensure a satisfactory functional and aesthetic result. Moreover, the donor site defect needs to be closed, with as little as possible functional or aesthetic impairment.

PATIENT AND METHOD

A 60-year-old male is presented with a history of squamous cell carcinoma of the left lower lip and chin area in whom the tumour was resected and treated by adjuvant radiotherapy. The follow-up was complicated by chronic inflammation of the left mandibular body as a sequel of radiotherapy; it resulted with partial bone destruction, and soft tissue dehiscence. He was admitted for repair and treatment of the infected mandibular osteoradionecrosis. A supraclavicular artery island flap was used to close the mandibular soft tissue defect.

CONCLUSION

The shoulder provides a relatively good skin texture and match to provide cover and lining for defects in the lower part of the face, in combination with minor donor site morbidity.

Castleman disease: a case with atypical presentation

Castleman disease is a benign lymphoproliferative disorder characterized by enlarged lymph nodes. In children the disease is rare, usually localized, and asymptomatic. Resection of the node is almost always curative. A case is reported that was diagnosed as hyaline vascular-type Castleman disease at 1 year of age. The disease recurred from infraclavicular region in addition to primary site, even though total excision was performed. Although the disease is mullticentric after recurrence, the patient has no systemic symptoms.

[The technique and location of secondary donor sites of vascularized bone grafts in the therapeutic arsenal of the plastic surgeon]

Most of the donor sites for conventional bone grafts can also provide vascularised bone grafts. Increased progress in vascular research has enabled the harvesting of grafts that are increasingly reliable and versatile. This work does not give emphasis to classic vascularised bone transfers like the iliac crest, the fibula or the lateral border of the scapula but highlights 'secondary' sites which are often underutilized. Several donor areas are studied; the upper limb including the clavicle, the lower limb, the thorax and the cranium. The hands and toes, which constitute a specific entity, are excluded. In each chapter the authors have emphasised the fundamental points relating to the anatomy, the technique of harvesting and the indications.

The Clavipectoral Osteomyocutaneous Free Flap

Microvascular free tissue transfer has revolutionized head and neck reconstruction and currently is considered the most successful and reliable method of primary oromandibular reconstruction. This study was designed to assess the feasibility of full thickness free vascularized transfer of the clavicle based on the clavicular branch of the thoracoacromial artery and the soft tissue component associated with the thoracoacromial axis. Forty dissections of the pectoral region were performed on 26 cadavers. The anatomic relations of the region and the thoracoacromial arterial and venous systems were documented in detail. Selective ink injections of the thoracoacromial arterial branches were also performed on fresh cadavers. The clavicle was supplied mainly by the clavicular artery (medial three quarters), with minor contribution from the deltoid artery (lateral quarter). An average of 16.1 cm (range of 12 to 20 cm) was obtained with total clavicular harvest and the clavicle had sufficient width and height to support dental implants. Two soft tissue donor sites were associated with the thoracoacromial artery: the sternocostal head of the pectoralis major muscle, with the overlying skin supplied by the pectoral artery, and the clavicular head of the pectoralis major muscle, with the overlying skin supplied by the deltoid and clavicular arteries. Sensory innervation of the upper chest was supplied through the supraclavicular nerves, whereas the lateral pectoral nerve supplied motor innervation to both heads of the pectoralis major muscle. The anatomy of the clavipectoral donor site and the first case of full thickness free clavicular transfer for mandibular reconstruction in the English literature are presented. The donor site is an excellent source of well vascularized, thin, pliable, hairless, potentially innervated (motor and sensory) soft tissue, along with up to 20 cm of clavicular bone. The surgical anatomy is familiar to the head and neck surgeon. The harvesting does not require repositioning of the patient and is amenable to a two-team, simultaneous approach. The functional and cosmetic donor site morbidity is minimal even with clavicular harvest. The major disadvantage of this flap is the relatively short pedicle. The authors conclude that the thoracoacromial system provides a free flap with osseous and soft tissue components that are well suited for oromandibular reconstruction.

The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures

Mentosternal contractures represent a surgical challenge to the plastic and reconstructive surgeon. We add the supraclavicular artery island flap to the armamentarium of surgical procedures to improve the function and cosmesis of disfigured patients. Since July of 1994, the supraclavicular artery island flap has been used at our institution for releasing postburn mentosternal contractures in eight patients. The flap was planned to be 4 to 10 cm in width and 20 to 30 cm in length with the supraclavicular vessels running axially. All donor defects could be closed primarily without significant postoperative complications in seven of the eight patients. All flaps healed primarily, achieving a good functional result by complete removal of contracting scar tissue for all patients; one donor site healed by secondary intention. We found the supraclavicular artery island flap both reliable and safe for immediate resurfacing after resection of cervical scars. The anatomy, operative procedure, and postoperative results of the supraclavicular artery island flap are outlined in this paper.

Transverse cervical artery fasciocutaneous free flap for head and neck reconstruction: initial anatomic and dye studies

METHOD

The bilateral transverse cervical arteries of 16 fresh cadavers were exposed by an infraclavicular midline approach. Each artery was cannulated, and methylene blue dye was infused to delineate the skin territory subserved by the vessel. The two major infusion skin patterns obtained allowed fashioning of a thin fasciocutaneous flap incorporating supraclavicular skin, which was based on the transverse cervical artery; or a larger flap additionally incorporating upper back skin and varying amounts of trapezius muscle, when the artery had a dorsal scapular artery branch. Depending on the skin pattern, either scapula or clavicle could be transferred with the other soft tissues.

RESULTS

The skin territory of the transverse cervical artery is caused to vary by the presence or absence of its dorsal scapular artery branch. The supraclavicular portion of the flap is recommended for repair of facial and nasal lesions because of its close match in color and texture to facial skin. Oral lesions can also be reconstructed with this flap because of its pliability.

CONCLUSION

The free flap based on the transverse cervical artery pedicle appears to be a useful addition to the armamentarium of flaps for head and neck reconstruction. Clinical use of the flap is ongoing and will be subsequently reported.

Vascularised reconstruction of the clavicle

A rare malignant tumour presented as a pathological fracture in the clavicle of an 11-year-old girl. This was resected and the defect reconstructed using a pedicled bilobed flap based on the thoracodorsal system with latissimus dorsi and serratus anterior with a rib to replace the clavicle. The innervation of both donor muscles was preserved. The reconstruction was cosmetically acceptable and maintained the function of the thoracohumeral articulation. Although the use of vascularised rib grafts in composite flaps is well documented, this is the first report of clavicular reconstruction using the technique.

The arterial supply of the clavicle

This report based on delineation of the arterial system with 3 component plastic material on 10 human cadavers describes the arterial supply to the clavicle. The study was performed in 2 parts. One part, which showed the total arterial supply to the clavicle and one part with selective injections of the relevant arteries, with the intention of finding a central nutrient arterial supply to the clavicle. Three arteries were found to supply the clavicle: the suprascapular a.; the thoracoacromial a.; and the internal thoracic (mammary) a. The main supply was primarily periosteal. No nutrient artery was found.

Anatomic basis for the construction of a musculotendinous flap derived from the pectoralis major muscle

The vascularization, innervation and termination of the clavicular portion of the pectoralis major muscle were studied by dissection of 7 adult subjects and 2 fetuses. The vascular and nervous autonomy of the clavicular portion was confirmed. Blood-supply was effected by 2 arteries and innervation by an independent nerve. The exact distribution of the fibers composing the pectoralis major and their complex insertion are described. It is concluded that the clavicular portion can be employed as an active muscle transplant to the head of the humerus when the short rotator muscles of the shoulder are ineffective.

Clavicular periostitis: an unusual complication of percutaneous subclavian venous catheterization

The first three cases, to the authors' knowledge, of benign clavicular periostitis resulting from percutaneous subclavian venous catheterization in children and the mechanism of this iatrogenic trauma are discussed.

Radiographic anatomy of the internal mammary arteries

The radiographic anatomy of the IMAs is described based on bilateral selective arteriography in 100 patients with coronary artery disease. The right and left IMAs were identical in caliber in their mid portions in 94% of cases. Fifteen percent of the IMAs measured less than 2 mm in luminal diameter at the level of the fourth costal cartilage. The side branches showed a great deal of variability and asymmetry in their origin and distribution. The understanding of the radiographic anatomy of the IMA and its branches is helpful in preoperative appraisal and is crucial for postoperative evaluation of the IMA grafts.

Hemophilic pseudotumor. Diagnosis, treatment, and complications

Patients with hemophilia are living longer as a result of improved therapeutic measures. Associated with this longevity is the increased occurrence of complications affecting the osseous system. One of the more serious bone complications is the hemophilic pseudotumor or hemophilic cyst. We studied its diagnosis, treatment, and complications, and report a case of an early hemophilic cyst occurring in a new location, the proximal part of the left clavicle. The increased incidence of this complication should alert the clinician to the possibility of these lesions appearing in previously unreported sites and demonstrating atypical roentgenographic features. Early recognition and treatment is essential if optimal therapeutic results are to be obtained.