Abdominal Pocket Research Articles

The Role of Tissue Expansion Before Baclofen Pump Insertion in the Pediatric Population.

Tissue expansion is a well-established technique for soft tissue reconstruction in the pediatric population. We present a case series of this technique to create a safe pocket for baclofen pump insertion to minimize risk of complications including pump migration, extrusion, wound dehiscence and infection. A case series of 3 pediatric patients undergoing tissue expansion prior to baclofen pump insertion at a single center in Melbourne. The expansion procedure was performed by senior surgeon N Low in all cases, and patients followed up 6 months after expander-pump exchange. The study was conducted over a 4-year period 2019 to 2023. We suffered 2 minor complications with the tissue expansion process including cellulitis and pump deflation. Neither complication precluded further tissue expansion nor led to premature removal of the expander. All patients proceeded to safely complete expander-pump exchange. One patient suffered a small (6 mL) abdominal seroma associated with pump insertion, which required no intervention. All patients have had a successful outcome 6 months after pump insertion. We describe a reliable and reproducible approach in creating a safe abdominal wall pocket to better accommodate baclofen pump insertion. Our series has overcome the imbalance between device size and abdominal wall pocket, now offering an alternative approach to achieve the safe delivery of intrathecal baclofen in the pediatric population.

3D-printed scaffolds with controlled-releasing compounds for ectopic activation of dormant ovarian follicles

Throughout a woman’s reproductive life, hundreds of functioning follicles are activated for development, while thousands of dormant follicles remain in the ovaries. Dormant follicle activation in vitro is an effective clinical strategy for women with fertility needs who suffer from ovarian dysfunction. However, activating dormant follicles in vivo is still a challenge due to difficulties such as delivering stimulators to local sites. Here, we developed a compound-preloaded microporous scaffold by combining three-dimensional (3D) printing techniques with pharmacological activators to support and stimulate the activation and development of primordial follicles. The gelatin/alginate composite scaffolds exhibited exceptional mechanical properties and biological compatibility, effectively supporting the survival of ovarian granulosa cells for more than 7 days, which is essential for oocyte development. Furthermore, the ovarian tissue-scaffold complex successfully survived after transplantation under the mouse kidney capsule, demonstrating its excellent biocompatibility. After pre-mixing widely used clinical activators into the bio-ink, the scaffold had the ability to gradually release the mixture of compounds, effectively activating primordial follicles. By transplanting the ovary-scaffold complex containing activators into the mouse abdominal subcutaneous pocket, dormant follicles could be activated subcutaneously and developed into growing follicles. The number of growing follicles is approximately three times higher compared to the group without activators. In conclusion, by integrating biomaterials, activators, and 3D printing technology, we have developed 3D-printed biological scaffolds that can ectopically support primordial follicle activation and development in vivo. This novel approach could provide a promising strategy for treating ovarian insufficiency and endocrine disorders in the clinic, without the need for in situ ovarian tissue grafting.

Complications of intrathecal baclofen therapy in children and young adults

OBJECTIVE The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. METHODS The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children’s hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). RESULTS One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. CONCLUSIONS Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

A Two-stage Surgery for Completely Degloving Injury of Multiple Fingers: a Retrospective Cohort Study

PurposeThe completely degloving injury of multiple fingers is a challenging clinical problem. Based on our technical experience, a novel two-stage surgery of abdominal hypodermal pocket followed by separation and full thickness skin grafting was conducted. MethodsFrom January 2017 to August 2020, 7 cases (17 fingers) of degloving injury of multiple whole fingers who were treated in a two-stage fashion; an emergency first stage surgery of abdominal hypodermal pocket embedding and a second stage surgery (4 weeks later) of full thickness skin grafting, were retrospectively studied. The results were evaluated according to the patient subjective evaluation, static two-point discrimination and disabilities of the arm, shoulder and hand (DASH) scores and active range of motion (ROM) of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints. ResultsAll seven cases healed successfully, although two cases experienced distal phalanx necrosis. The affected fingers recovered with a good appearance and soft texture and the results were either satisfying or acceptable for all participants. The active ROM of MP joint ranged from 55° to 64° with an average of 59.5° three months postoperatively and ranged from 70° to 81° with an average of 77.2° six months postoperatively, while the active ROM of PIP joint ranged from 58° to 69° with an average of 64.1° three months postoperatively and from 76° to 86° with an average of 81° six months postoperatively. One year postoperatively, the static two-point discrimination ranged from 7 to 10mm with an average of 8.6mm and DASH scores ranged from 25 to 42 with an average of 37. ConclusionA novel two-stage surgery of abdominal hypodermal separated pockets followed by full thickness is an effective and worthwhile option for treating the completely degloving injury of multiple fingers.

Unseparated Temporal Muscle and Duramater Cranioplasty Methods Following Decompressive Craniectomy: Technical Note.

Cranioplasty (CP) is used to repair cranial defects after decompressive craniectomy. During this procedure, the temporal muscle can contract or retract toward the base and adhere to the scalp flaps above and/or below the dura. Several complications including functional and cosmetic problems can occur following CP. This study presents the technical notes and outcomes of CP. This retrospective observational study collect data of CP-procedures using unseparated muscle-dura technique performed at our hospital in 2019-2022. Technical note is presented regarding the lack of separation of the temporal muscles from the dura mater. A bone flap or titanium mesh was placed above the temporal muscle layer, which was still attached to the dura mater. Functional outcomes were evaluated using OHIP-14 Questionnaire to assess mastication quality. Twenty-three patients were included in this study. Initial surgeries were mostly caused by trauma (65.2%). Most patients underwent autologous bone flap CP (52.2%), during which the bone flap was stored in either the abdominal subcutaneous pocket or cryoprecipitated. Only one patient experienced mastication problems after CP (p<0.001). Temporal hollowing remained a problem in this technique. However, dissection of the temporalis muscle to reduce temporal hollowing can cause facial nerve injuries and masticatory problems. Due to the lack of temporal muscle manipulation, our patients had minimal mastication problems. CP should be performed to improve functional and aesthetic outcomes. A CP technique with the temporal muscle unseparated from the dura mater can be selected to avoid damage to the muscle and mastication problems after surgery.

ID: 214681 Longitudinal Data From the Targeted Drug Delivery (TDD) Product Surveillance Registry: Pump Pocket Location

TDD with programmable intrathecal drug delivery systems (IDDS) has been approved for chronic malignant and nonmalignant pain treatment since 1991 and severe spasticity since 1992. Early clinical IDDS studies specified an “abdominal pocket” as the pump implant location, resulting in this as the defined on-label location. Alternate pump pocket locations are preferred by some implanting physicians for patient-specific reasons, but full evaluation of the risks and benefits of these alternate pump sites has not been performed. Presented here is an evaluation of real-world registry data on the potential risks and benefits of 7415 pump implants.

Recurrent abdominal dislodgement of intrathecal pump and utility of infraclavicular site for patients with elevated body mass index: illustrative case.

Intrathecal baclofen, delivered via implanted pump, has been used to manage spasticity for approximately 40 years. The device is typically subcutaneously or subfascially implanted in the abdominal wall. There are very few cases reported of the pump being implanted in other locations. This case describes the complicated course of a patient presenting with multiple episodes of catheter malfunction related to pump flipping in the abdominal pocket. The patient was successfully treated with repositioning of the pump into the infraclavicular fossa. Infraclavicular placement of the implanted pump allowed for a more secure pocket base for this patient and less strain applied to the pump, minimizing the risk of disruption of pump positioning and interruption of drug delivery.

PO203 / #915 LONGITUDINAL DATA FROM THE TARGETED DRUG DELIVERY (TDD) PRODUCT SURVEILLANCE REGISTRY: PUMP POCKET LOCATION: E-POSTER VIEWING

TDD with programmable intrathecal drug delivery systems (IDDS) has been approved for cancer and noncancer pain treatment since 1991 and severe spasticity since 1992. Early clinical IDDS studies specified an “abdominal pocket” as the pump implant location, resulting in this as the defined on-label location. Alternate pump implant locations are often necessary for patient-specific reasons, but full evaluation of the risks and benefits of these alternate pump sites has not been performed. Presented here is an evaluation of real-world registry data on the potential risks and benefits of alternate pump implant locations.

Bone Flap Preservation in Subcutaneous Abdominal Pocket for Decompressive Craniectomy

Summary:We report our experiences of two pediatric cases in which a bone flap was preserved in the subcutaneous abdominal pocket for decompressive craniectomy. In one case, the bone flap was divided and preserved for cranioplasty without complications; in the other case, the bone flap was left intact as one piece. In pediatric patients, the storage space for a bone flap is sometimes difficult to achieve, and the technique described herein is useful in such situations. Notably, because the bone resorption rate with cryopreservation is higher in pediatric patients, in vivo preservation may be more useful in this population.

Continuous Ultrasonic Transit‐Time Blood Flow and Arterial Blood Pressure Monitoring in Freely Moving Sprague‐Dawley Rats via Implantable Telemetry

BACKGROUNDSimultaneous blood flow and pressure measurements provide a more comprehensive hemodynamic assessment in cardiovascular studies. However, current cardiac output (CO) measurements, by flow probes or imaging, require either anesthesia or a tethered setup, which result in limitations due to anesthesia effects and/or monitoring time.OBJECTIVEThe objective of this study was to use an implantable telemetry device (EndoGear (EG), Transonic Systems Inc., Ithaca, NY) to measure continuous CO (real‐time ascending aortic blood flow), and mean arterial pressure (MAP) in conscious, freely moving rats and to verify the ability of the system to capture well‐known circadian oscillations in major cardiovascular parameters.METHODSAll procedures were approved by the Institutional Animal Care and Use Committee of Wayne State University and complied with the NIH Guide for the Care and Use of Laboratory Animals. Male Sprague‐Dawley rats were implanted with EG transmitters to continuously monitor CO, MAP, temperature, and activity for 5 weeks. An ultrasonic transit‐time flow probe was placed around the ascending aorta via a right lateral thoracotomy (4th intercostal space). The pressure catheter was inserted into the iliac artery and advanced (approximately 2.5 cm) into the abdominal aorta, while the transmitter was implanted intraperitoneally via a midline laparotomy approach. The inductive power receiver associated with the implant was positioned in an abdominal subcutaneous pocket. After surgery, rats received thermal support, prophylactic analgesics, and antibiotics, as well as fluid supplementation. Body weight, food and fluid intake were monitored daily for the first 10 days and then bi‐weekly until the end of the study. Animal checks and necessary handling were conducted at specific times to minimize circadian disturbances.RESULTSChanges in MAP, heart rate (HR, captured from pressure and flow traces), CO, stoke volume (SV, calculated as CO/HR), and temperature revealed, as expected, a clear circadian pattern characterized by lower values during the light phase. MAP decreased by ~5%, from 96.9 ± 0.15 to 92.1 ± 0.19 mmHg (p&lt;0.05). HR decreased by ~10%, from 369 ± 3 to 329 ± 6 bpm (p&lt;0.05). CO decreased by ~14%, from 91.6 ± 1.79 to 78.4 ± 1.89 ml/min (p&lt;0.05). SV decreased by ~7%, from 245 ± 3.5 to 238 ± 1.4 μl (p&lt;0.05). The decreases in temperature and activity during the light phase were subtle yet significant.CONCLUSIONSThe telemetry device was able to effectively measure continuous changes in CO and MAP. Preservation of the circadian rhythm indicates favorable post‐operative outcome after extensive surgery and complex chronic implantation in rats.

Mucormycosis: An Uncommon Cutaneous Infection at Permanent Pacemaker-Implanted Site in a Very Low-Birthweight Baby

AbstractPermanent pacemaker implantation in low birthweight (LBW) babies with congenital complete heart block is extremely challenging due to a paucity of appropriate pulse generator placement pocket sites. The development of infection following an implantation procedure can pose a life-threatening risk to the patients. With more patients in the younger group receiving these devices than ever before and the rate of infection increasing rapidly, a closer look at the burden of infection and its impact on outcome of these patients is warranted. We report mucormycosis infection at the abdominal pacemaker pocket site of an infant requiring pacemaker explantation and re-insertion into the intrapleural space.

Improved Abdominal Hypodermal Pocket for Salvage of the Amputated Fingertip (Tamai Zone I)

Improved Abdominal Hypodermal Pocket for Salvage of the Amputated Fingertip (Tamai Zone I)

Cranioplasty with Subcutaneously Preserved versus Cryopreserved Autologous bone flaps after Decompressive Craniectomy- A Comparative Study of 40 Cases

Background: After decompressive craniectomy for acute brain swelling, bone flaps need to be stored in a sterile fashion until cranioplasty. We can preserve autologous bone flap as a freeze-preserved state or within abdominal subcutaneous tissue. The aim of this study is to compare the cryopreservation with subcutaneous abdominal preservation regarding the effectiveness and safety.&#x0D; Methods:This is an interventional study. The clinical data of 40 patients underwent decompressive craniectomy and subsequent cranioplasty with autologous bone flaps in Neurosurgery Department of Shaheed Shiek Abu Naser Specialized Hospital and others private Medical Colleges in Khulna from Jan 2018 –December2019.20 patients under cranioplasty using autologous bone stored in ultra low freezer.. Another 20 patients cranioplasty with bone flap preserved in subcutaneous abdominal pocket. The analysis included the rate of complications, bone resorption, and reoperation to compare between SP group and CP group.&#x0D; Results: The mean age was found 35.10(±13.34) years in subcutaneous preserved group and 39.90(±16.40) years in cryopreservation group with male predominance was observed in both groups.The rate of complications occurred in 4 (20%) in the SP group and3 (15%) in the CP group( P =0.677). The rate of bone resorption in SP group was 5.0% and CP group was15.0% (P=0.292). Reoperation in subcutaneous preservation group was 2(10.0%) and in cryopreservation group was 3(15%). The difference was not statistically significant between two groups (p = 0.633).&#x0D; Conclusion: SP and CP both might be effective and safe methods for the storage of bone flaps for cranioplasty. There were no significant difference in complications, bone resorption , reoperation among two groups. However, identifying of the method that gives better results might depend on the individual surgeons preference and available equipment.&#x0D; Bang. J Neurosurgery 2021; 10(2): 201-205

Autologous Bone Cranioplasty: A Retrospective Comparative Analysis of Frozen and Subcutaneous Bone Flap Storage Methods

The use of autologous bone for cranioplasty offers superior cosmesis and cost-effectiveness compared with synthetic materials. The choice between 2 common autograft storage mechanisms (subcutaneous vs. frozen) remains controversial and dictated by surgeon preference. We compared surgical outcomes after autologous bone cranioplasty between patients with cryopreserved and subcutaneously stored autografts. Ten-year retrospective comparative analysis of patients undergoing cranioplasty with autologous bone stored subcutaneously or frozen at a tertiary academic medical center. Ninety-four patients were studied, with 34 (36.2%) bone flaps stored subcutaneously and 59 (62.8%) frozen. The 2 groups were similar in demographics, comorbidities, and craniectomy indication, with only body mass index and race differing statistically. The mean operation time was greater within the subcutaneous group (P < 0.001), which also had a greater number of ventriculoperitoneal shunt (VPS) placements (P= 0.02). There were no significant differences in complications, readmissions, unplanned reoperations, or length of stay between the 2 groups. VPS placement during cranioplasty increased length of stay (P < 0.001), and placement prior to cranioplasty increased both length of stay (P= 0.009) and incidence of hospital-acquired infection (P= 0.03). Subcutaneous and frozen storage of autologous bone result in similar surgical risk profiles. Cryopreservation may be preferred because of shorter operation time and avoidance of complications with the abdominal pocket, whereas the portability of subcutaneous storage remains favorable for patients undergoing cranioplasty at a different institution. VPS placement prior to cranioplasty should be avoided, if possible, due to the increased risk of hospital-acquired infection.

Minimally invasive percutaneous epicardial placement of a prototype miniature pacemaker with a leadlet under direct visualization: A feasibility study in an infant porcine model

Pacemaker implantation in infants is limited to epicardial lead placement and an abdominal generator pocket. We propose a minimally invasive solution using a prototype miniature pacemaker with a steroid-eluting leadlet that can affix against the epicardium under thoracoscopy. The purpose of this study was to evaluate the safety and feasibility of acute implantation of a prototype miniature pacemaker in an infant porcine model. A self-anchoring 2-channel access port was inserted into a 1-cm incision left of the subxiphoid space. A rigid thoracoscope with variable viewing angle was inserted through the main channel to visualize the heart under insufflation. An 18-G needle through the second channel accessed the pericardial space, which was secured with a 7-F sheath. The leadlet was affixed against the epicardium using a distal helical side-biting electrode. The sheath, thoracoscope, and port were removed, and the pacemaker was tucked into the incision. Ventricular sensing, lead impedances, and capture thresholds were measured. Twelve piglets (weight 4.8 ± 1.9 kg) had successful device implantation. The median time from incision to leadlet fixation was 21 minutes (interquartile range [IQR] 18-31 minutes). The median lead impedance was 510 Ω (IQR 495-620 Ω). The median R-wave amplitude was 5.7 mV (IQR 4.2-7.0 mV). The median capture threshold was 1.63 V (IQR 1.32-2.97 V) at 0.4 ms pulse width and 1.50 V (IQR 1.16-2.38 V) at 1.0 ms pulse width. There were no complications. Minimally invasive epicardial placement of a prototype miniature pacemaker under thoracoscopy was safe and avoided open chest surgery and creation of an abdominal generator pocket.

O 028 - How do 3D skeletal parameters influence kinetics?

Pacemaker implantation in infants is limited to epicardial lead placement and an abdominal generator pocket. We propose a minimally invasive solution using a prototype miniature pacemaker with a steroid-eluting leadlet that can affix against the epicardium under thoracoscopy.The purpose of this study was to evaluate the safety and feasibility of acute implantation of a prototype miniature pacemaker in an infant porcine model.A self-anchoring 2-channel access port was inserted into a 1-cm incision left of the subxiphoid space. A rigid thoracoscope with variable viewing angle was inserted through the main channel to visualize the heart under insufflation. An 18-G needle through the second channel accessed the pericardial space, which was secured with a 7-F sheath. The leadlet was affixed against the epicardium using a distal helical side-biting electrode. The sheath, thoracoscope, and port were removed, and the pacemaker was tucked into the incision. Ventricular sensing, lead impedances, and capture thresholds were measured.Twelve piglets (weight 4.8 ± 1.9 kg) had successful device implantation. The median time from incision to leadlet fixation was 21 minutes (interquartile range [IQR] 18–31 minutes). The median lead impedance was 510 Ω (IQR 495–620 Ω). The median R-wave amplitude was 5.7 mV (IQR 4.2–7.0 mV). The median capture threshold was 1.63 V (IQR 1.32–2.97 V) at 0.4 ms pulse width and 1.50 V (IQR 1.16–2.38 V) at 1.0 ms pulse width. There were no complications.Minimally invasive epicardial placement of a prototype miniature pacemaker under thoracoscopy was safe and avoided open chest surgery and creation of an abdominal generator pocket.

Totally Implantable IV Treprostinil Therapy in Pulmonary Hypertension Assessment of the Implantation Procedure

Prostacyclins improve symptoms and survival in pulmonary arterial hypertension (PAH). In response to risks associated with external delivery systems, an implantable IV infusion system was developed. A multicenter, prospective, single-arm, clinical trial (DelIVery for PAH) was conducted to evaluate this system for treprostinil in PAH. This analysis describes the findings related to the implant procedure. Patients (N= 64) with PAH (World Health Organization group 1) receiving stable IV treprostinil were enrolled. Patients were transitioned to a temporary peripheral IV infusion catheter prior to the procedure. System implantation was performed at 10 centers under general anesthesia or deep IV sedation by clinicians from various specialties. Central venous access was via the cephalic, subclavian, jugular, or axillary vein. Using an introducer and fluoroscopic guidance, the distal tip of the infusion catheter was placed at the superior caval-atrial junction. The catheter was tunneled from the venous access site to an abdominal subcutaneous pocket, where the pump was placed. Of the 64 patients enrolled, four exited prior to implantation. All 60 implant procedures were successful. At baseline, all patients were receiving treprostinil via an external pump at a mean dose of 71.4 ± 27.8ng/kg/min (range: 22-142ng/kg/min). The implant averaged 102 ± 32min (range: 47-184 min). Clinically significant implant procedure-related complications included one pneumothorax, two infections, and one episode of atrial fibrillation. There were three postimplantation catheter dislocations in two patients. Common implant-related events that were not complications included implant site pain (83%) and bruising (17%). The procedure for inserting a fully implantable system for treprostinil was successfully performed, with few complications. ClinicalTrials.gov; No.: NCT01321073; URL: www.clinicaltrials.gov.

Severe Calcification in the Abdominal Pocket of an Implantable Pulse Generator (IPG) in a Patient on Long-Term Hemodialysis

Introduction: Ectopic mineralization has been described in patients with end-stage renal failure managed with long-term hemodialysis. This study reports the first case of severe focal ectopic calcification in an implantable abdominal pulse generator pocket. The patient has a medical history of long-term hemodialysis and failed back surgery syndrome. The failed back surgery syndrome is treated with a spinal cord stimulator and an implantable pulse generator (IPG). Case report: Severe ectopic calcification of an implantable abdominal pulse generator pocket was observed in a 58-year-old female patient undergoing IPG relocation. The patient had a medical history of long-term hemodialysis for end-stage renal failure. She is also known with a spinal cord stimulator and an IPG for failed low back surgery syndrome. Microbiological study was negative and histopathological analysis confirmed the presence of focal calcifications in the implantable abdominal pulse generator pocket and on the IPG itself. Discussion: Extra-cellular matrix (ECM) calcification is highly prevalent in patients with end-stage renal failure. The exact mechanism remains unclear. Physiopathological disturbance in the calcium and phosphate homeostasis finally and a pro-inflammatory environment result in soft tissue. Conclusion: This is to our knowledge the first case reported in the literature of dystrophic severe focal ectopic calcification in the abdominal pocket of an implantable pulse generator (IPG) in a patient on long-term hemodialysis. Pain physicians should be aware of this phenomenon.

Poster 441 Rare Occlusion of a Baclofen Pump Catheter Due to Rotation of Pump in the Abdominal Pocket: A Case Report

PM&RVolume 8, Issue 9S p. S304-S305 Pain & Spine Medicine Poster 441 Rare Occlusion of a Baclofen Pump Catheter Due to Rotation of Pump in the Abdominal Pocket: A Case Report Matthew W. Wilson MD, Matthew W. Wilson MD Vidant Rehab Center/East Carolina University/Brod, Greenville, North Carolina, United StatesSearch for more papers by this author Matthew W. Wilson MD, Matthew W. Wilson MD Vidant Rehab Center/East Carolina University/Brod, Greenville, North Carolina, United StatesSearch for more papers by this author First published: 24 September 2016 https://doi.org/10.1016/j.pmrj.2016.07.365Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume8, Issue9S2016 AAPM&R Annual Assembly AbstractsSeptember 2016Pages S304-S305 RelatedInformation

Abdominal Pocket Method as a Salvage Procedure for Vascular Insufficiency After Distal Digital Replantation

To assess the utility of abdominal pocketing of a deepithelialized reattached digit to allow for neovascularization as a salvage procedure for circulatory insufficiency after digital replantation. We performed this method in Tamai zone II cases in which microsurgical vascular anastomosis was expected to be difficult based on the findings at the initial operation. From 2008 to 2014, 5 injured digits from 5 patients (mean age, 34 years; range: 25-54 years) underwent the abdominal pocket method as a salvage procedure for postoperative circulatory insufficiency. We evaluated the survival incidence, the timing between operations, and the duration of the second operation. During this study period, 7 amputated digits from 7 patients underwent vascular reanastomosis. We also evaluated the survival incidence for these cases. Four out of 5 replanted digital tips survived. The mean time between the initial operation and the onset of vascular problems was 82 hours, and the mean duration of the second operation was 48 minutes. The survival incidence for reanastomosed cases was 6 out of7. The abdominal pocket method is useful for treating circulatory insufficiency after digital replantation in Tamai zone II cases in which microsurgical vascular reanastomosis was expected to be difficult based on the findings at the initial operation. Therapeutic IV.