Bridging Vessels Research Articles

The bridging vessel sign: A diagnostic clue to determine the origin of pelvic mass

The bridging vessel sign: A diagnostic clue to determine the origin of pelvic mass

568: Validation of a scoring system for prediction of morbidly adherent placenta in high risk population

To validate sonographic based scoring system in prediction of morbidly adherent placenta (MAP) in high risk population. A retrospective cohort study was conducted including pregnant women with previous uterine scar (Cesarean section, dilatation and curettage, etc.) and anterior placenta (previa or not) who had Ultrasound evaluation antenatal and delivered in our center. Using three previously proposed sonographic-based score system published by Tovbin et al, Rac et al, and Gilboa et al to predict MAP, Ultrasound images from the first study of second or third trimester performed in our unit were reviewed by a junior Maternal Fetal Medicine Specialist blinded from the final pathology report and/or surgical notes. Parameters assessed by Tovbin included number of previous cesarean sections, number and size of placental lacunae, obliteration of demarcation between uterus and placenta, location of the placenta and Doppler assessment. Rac assessed two or more previous caesarian sections, Lacunae grade, sagittal smallest myometrial thickness, anterior placenta and bridging vessel. Finally, Gilboa evaluated presence and number of placental lacunae, interruption of the uterus-bladder interface, obliteration of demarcation between the uterus and the placenta. 55 pregnant women who met the inclusion criteria were reviewed. Nine (16%) cases of MAP were found at the time of delivery and all had hysterectomy. Pathology report confirmed operative finding. Scoring systems designed by Tovbin et al, Rac et al and Gilboa et al identified 88%, 77% and 55% of cases of MAP, respectively. When the scoring system ruled out MAP, Tovbin predicted 97%, Rac 95% and Gilboa 97%. In our cohort study, Tovbin had superior prediction of MAP than the other two scoring system. No difference was found to prediction negative cases of MAP for all three scoring system and appear to be a useful tool. Larger sample and further statistical analysis should be performed before implementation of scoring system in a routine high risk patient assessment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Combined Myocardial Bridge and Coronary Vessel Disease Requiring Coronary Artery Bypass Grafting and Myotomy of the Myocardial Bridge.

Myocardial bridging (MB) describes a band of myocardium that covers the epicardial surface of the coronary artery. This band can vary both in thickness and distance to which it covers the artery. It is broadly classified as superficial or deep, depending on the thickness of the covering muscle layer. It can be asymptomatic, or it could present with different complications. Reported complications have included ischemia and acute coronary syndromes, coronary spasm, ventricular septal rupture, and arrhythmias. MB is most commonly found in the middle segment of the left anterior descending (LAD) coronary artery. There is controversy with regard to therapy for symptomatic patients who are refractory to medical management. Percutaneous coronary intervention and surgical myotomy (unroofing) have been proposed; yet, each one has its pros and cons. MB can be associated with the development of atherosclerosis proximal to the MB segment in the involved coronary artery, and patients can present having both pathologies. We present a case series of six patients with atherosclerotic coronary lesions requiring coronary artery bypass grafting (CABG) with an accidental perioperative finding of MB, which required myotomy.

Study on the Assessment of Impact Force Between Ship and Bridge Pier

The bridge crossing water way is in the risk of impact by vessel, and thus it is very important to estimate the collision force for the safety of bridge. The impact force between bridge pier and vessel is investigated by numerical simulation and various empirical formulae. The collision response between a 5000t DWT bulk carrier with bulb bow and rigid bridge pier is simulated in the explicit finite element code of ANSYS LS-DYNA. The difference of the impact force between the empirical formulae and FE analysis are discussed. Based on the comparison of the results, the coefficient in the formulae is suggested for obtaining more accurate assessment of impact force.

COMPARISON BETWEEN THE ROLE OF TRANSABDOMINAL ULTRASOUND VERSUS TRANSVAGINAL ULTRASOUND IN EVALUATION OF PLACENTAL INVASION IN CASES OF PLACENTA PREVIA ANTERIOR WALL WITH PREVIOUS UTERINE SCAR

Background: Accurate antenatal diagnosis of an abnormally invasive placenta (AIP), allowing multidisciplinary management at the time of delivery, has been shown to improve maternal and fetal outcomes. Placenta previa and previous cesarean section are the two most important known risk factors for AIP. Objective: Comparison between the role of transabdominal ultrasound (TAS) versus transvaginal ultrasound (TVS) in evaluation of placental invasion in cases of placenta previa anterior wall with previous uterine scar applying the unified ultrasonography descriptors suggested by the European working group on abnormally invasive placenta EW-AIP. Patients and Methods: Fifty pregnant women with persistent placenta previa (after 28 weeks’ gestation) were prospectively enrolled into this study. Both transabdominal and transvaginal ultrasound were performed by two different operators who were blinded to the results of each other. The placenta was studied as regarding the exact localization and the unified descriptors were applied and evaluated by TAS and TVS. The ultrasound findings were analyzed with reference to the final diagnosis made during cesarean delivery and histopathological examination. Results: Abnormally invasive placenta and its variants were found in 43 patients at the time of cesarean delivery, and were later confirmed by histopathological evaluation. As regards Grey-scale criteria; the accuracy of detection of the loss of the retro placental clear zone was 76% by TVS and 54% by TAS, while that of the abnormal placental lacunae was 92 % by TVS and 88% by TAS. Myometrial Thinning detection accuracy was 66% by TVS and 72% by TAS, and Doppler assessment showed that the accuracy of detection of the uterovesical hyper vascularity was 84% by TVS and 88% by TAS. The detection of bridging vessels was 76% by TVS and 75% by TAS. The overall accuracy of detection of TAS was 91%, whereas that of TVS was about 97.1%. Conclusion: Both transabdominal and trasnvaginal ultrasound were complementary to each other with an upper hand to transvaginal ultrasound, with the safety of TVS being confirmed. The unified descriptors were found to be reliable in accurate diagnosis.

Complex Internal Carotid Aneurysms Treated by Superficial Temporal Artery Trunk–Radial Artery–Middle Cerebral Artery Bypass Combined with Balloon Occlusion of Internal Carotid Artery

To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P= 0.0005). The STAT (P< 0.0001, P < 0.0001) and RAG (P < 0.0001, P= 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2= 0.762, P < 0.0001) and RAG (r2= 0.54, P= 0.0042) diameters were negatively correlated with MTT. STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.

Effect of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease complicated with ruptured aneurysm

Objective To investigate the safety and efficacy of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease with ruptured aneurysm. Methods Five patients with moyamoya disease or Moyamoya Syndrome complicated with ruptured aneurysms (5 aneurysms) were treated at Department of Neurosurgery, Henan Provincial People's Hospital from June 2016 to March 2018. All patients underwent extracranial and extracranial revascularization combined with craniotomy for aneurysm clipping. Five patients were followed up after operation. The results of follow-up were as follows: digital subtraction angiography (DSA) or perfusion weighted imaging (PWI) was used to evaluate the long-term cerebral revascularization and the effect of aneurysm. The recovery of neurological function was evaluated by modified Rankin scale (mRS) and activities of daily living scale (ADL). Results The operations of all 5 patients were successful. Intraoperative fluorescence angiography showed that the intracranial aneurysm did not develop and the bridge vessels were anastomosed unobstructed. No new blood foci were found in 5 patients with CT after operation and there were no complications such as infection, new infarction or bleeding. The follow-up time of 5 patients was 6 to 21 months, with an average of 17.6±1.7 months. DSA showed that the aneurysm did not develop and the bridge vessels were unobstructed in 5 patients at 6 months after operation. During the follow-up period, none of the 5 patients had any new neurological deficit symptoms, and there was no hyperperfusion hemorrhage or large-area cerebral infarction. At the last follow-up, the mRS of 5 patients was 0-3, with an average of 1.4±1.0. The ADL of 5 patients was 55-90, with an average of 76±12 at the last follow-up. Conclusion Cerebral revascularization combined with craniotomy seems safe and effective in the treatment of moyamoya disease with ruptured aneurysm. Key words: Moyamoya disease; Aneurysm, ruptured; Microsurgery; Cerebral revascularization; Treatment outcome

Optical coherence tomography angiography in best vitelliform macular dystrophy

PurposeTo report best vitelliform macular dystrophy (BVMD) with an intriguing pattern of vascular flow on optical coherence tomography angiography (OCTA). MethodsFour eyes of two patients with BVMD were evaluated. Complete ophthalmic examination including best corrected visual acuity (BCVA), spectral domain optical coherence tomography (SD-OCT), and OCTA were performed. Diagnosis was confirmed by electroretinography (ERG) and electrooculography (EOG) testing. ResultsAll eyes had the electrophysiologic confirmation of the BVMD. The first patient was 35 years old with BCVA of 20/20 and pseudohypopyon stage macular lesion in right eye (RE) and BCVA of 20/32 and vitelliruptive stage macular lesion in the left eye (LE). The second patient was 18 years old with BCVA of 20/25 and macular lesion in vitelliform stage in the RE and BCVA of 20/60 and choroidal neovascularization (CNV) in the LE. In all eyes, a distinct foveal avascular zone (FAZ) was not detectable in OCTA, with a bridging vessel in the FAZ. A dense subretinal capillary network compatible with CNV in the LE of second patient was observed. ConclusionIn our cases, we found bridging vessel in the FAZ, and it may be due to the effects of bestrophin on the calcium content and vascular endothelial growth factor (VEGF) secretion of the retinal pigment epithelium (RPE) cells.

Optical coherence tomography and intravascular ultrasound assessment of the anatomic size and wall thickness of a muscle bridge segment.

To use optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in assessing myocardial bridging (MB) vessel size and wall thickness. During stent implantation, MB is associated with complications, especially perforation. OCT and IVUS were performed in 56 patients with typical angiographic "milking" from November 2016 to May 2017. The vessel area and thickness in the MB segments and adjacent proximal and distal reference segments were measured and compared with eight normal left anterior descending (LAD) segment (no atherosclerosis in a segment that was at least 20 mm long and that began ~40 mm distal to the LAD ostium). Compared with the reference vessel size distal to the MB segment (6.3 ± 1.8 mm2 ), the IVUS-measured size of the tunneled vessel during diastole was significantly smaller (6.0 ± 1.9 mm2 , p < 0.05) (remodeling index = 0.79 ± 0.18). The minimum intramyocardial arterial wall thickness was 0.16 ± 0.02 mm, significantly thinner than that of the mean reference (0.22 ± 0.03 mm, p < 0.001). The location of the thinnest arterial wall was in the distal and middle MB segments in 45 (80.4%) and 11 (19.6%) patients, respectively, and was not related to the degree of systolic compression or remodeling index. The walls of the middle and distal MB subsegments, but not of the proximal MB subsegment, were thinner than that of the comparison group of normal LADs. The coronary vessel involved in an MB is both smaller and thinner than that of the adjacent non-MB segment. This may explain the increased frequency and severity of coronary perforation during stent implantation.

Abnormally adherent placenta

Advances in image-scanning technology have led to vast improvements in medicine, especially in the diagnosis of fetal anomalies and placenta evaluation. In general, two main technologies are used to obtain images within the uterus during pregnancy – ultrasound (US) and magnetic resonance imaging (MRI). US examination is the primary method of gravid uterus assessment because it is patient-friendly, effective, cost-efficient and considered to be safe. MRI is generally used when US cannot provide sufficiently high-quality images. It offers high-resolution fetal and placenta imaging with excellent contrast that allows visualization of internal tissues. Placenta percreta is the most feared form of abnormally adherent placenta. Its incidence has increased because of high cesarean section rates. The main imaging findings in abnormally adherent placenta are: • Loss of the “clear zone” or irregularity of the hypoechoic plane in the myometrium underneath the placental bed. •Abnormal placental lacunae. Presence of numerous lacunae including some that are large and irregular often containing turbulent flow. • Bladder wall interruption. • Placental bulge. Deviation of the uterine serosa away from the expected plane. The uterine serosa appears intact, but the outline shape is distorted. • Focal exophytic mass. Placental tissue seen breaking through the uterine serosa and extending beyond it. • Color Doppler imaging shows uterovesical hypervascularity. • Bridging vessels appearing to extend from the placenta across the myometrium and beyond the serosa into the bladder or other organs. Often running perpendicular to the myometrium. The key concern of this talk will be: • The risk of placenta accreta increases according the number of Cesarean-section. • Placenta accreta is mostly associated with placenta previa. • The most sensitive US finding for placenta accreta is the presence of placenta lacunae, that can also be observed in MRI. • MRI may aid in diagnosis by demonstrating increased intraplacental vascularity, fibrin band of dark T2 signal and direct placental invasion of adjacent structures.

Central nervous system involvement in acute lymphoblastic leukemia

It is well known that acute lymphoblastic leukemia (ALL) cells can invade the central nervous system (CNS), but the underlying mechanism of such invasion is still unclear. We discovered the direct routes taken by ALL cells when migrating into CNS in ALL model mice. We observed that ALL cells migrate along the external surface of vessels that pass directly between the vertebral or calvarial bone marrow and the subarachnoid space. The basement membrane of these bridging vessels is enriched in laminin. The laminin is recognized by integrin α6, which is expressed by ALL cells. The interaction between integrin α6 and laminin mediated the invasion of ALL cells. Furthermore, the expression of integrin α6 depends on PI3Kδ activity. Mice with ALL xenografts were treated with a PI3Kδ inhibitor, which decreased integrin α6 expression on ALL cells. This resulted in significant reductions in blast counts in the cerebrospinal fluid and in CNS disease symptoms. Our data suggest that the PI3Kδ inhibitor has potential to prevent CNS involvement in ALL.

816: Prediction of Morbidly adherent placenta using ultrasonographic Placenta Accreta Index (PAI)

The current study aims to evaluate the accuracy of an ultrasonographic placenta accreta index (PAI) for diagnosing morbidly adherent placenta (MAP). This study was a prospective cohort study included pregnant women referred to our ultrasound unit in a tertiary university hospital from March 2016 to February 2018 because of suspected MAP on a previous ultrasound examination All women were assessed using the PAI score based on the following: number and size of placental lacunae; presence of bridging vessels; the sagittal smallest myometrial thickness, the uterine-bladder interface thickness and the placental location. Additionally, the number of previous Cesarean deliveries was determined. All ultrasonographic evaluations were performed by an expert level II sonographer. The presence of MAP was determined by the surgeon at delivery and clinical data were recorded at time of delivery. Pathological diagnoses of placental invasion were available only in patients that underwent hysterectomy. In total, 137 pregnant women were included in the study, of whom 33 (24.1%) were diagnosed with MAP. The mean PAI score in women with focal accreta was significantly higher than the PAI score of placenta previa non-accreta (6.50±1.81 vs. 3.63±1.98, p<0.001). Similarly, the mean PAI score in women with total accrete was significantly higher than non-accreta (8.71±0.28 vs. 3.63±1.98, p<0.001). Receiver–operating characteristics (ROC) curve for prediction of MAP using PAI score yielded an area under the ROC curve of 0.911. The best cut-off point was 5.25 with 86% sensitivity and 88% specificity. All sonographic criteria of the PAI were significantly associated with MAP (p<0.0001). ROC curves for prediction of MAP using the number of placental lacunae and smallest myometrial thickness yielded an area under the ROC curve of 0.856 and 0.783 respectively. PAI is highly predictive of morbidly adherent placenta in patients at risk. This allows an adequate pre-operative planning and accurate timing of delivery in such cases

Ultrasound predictors of candidates for segmental resection in pregnants with placenta accreta

Objective: We aimed to assess the predictive values of individual sonographic findings of abnormal placentation to determine the candidates for segmental resectionStudy design: This was a retrospective review of 43 pregnancies with at least one prior cesarean delivery who received an ultrasound diagnosis of placenta previa or low-lying placenta with suspected abnormal placentation in the third trimester at our institution from 2015 through 2017. Sonographic images were reviewed by an investigator blinded to pregnancy outcome. Sonographic parameters were assessed including loss of retroplacental clear zone, irregularity and width of uterine-bladder interface, smallest myometrial thickness, presence of lacunar spaces, and bridging vessels. Diagnosis of placental invasion was based on histologic confirmation. Parameters were analyzed to predict candidates for conservative approach.Results: There were 27 cases with cesarean hysterectomy where as conservative approach was successful in 16 of the cases. Numbers of transfusions of packed red blood cells (2.6 vs. 1.7), fresh frozen plasma (2.3 vs. 0.9) and mean smallest retroplacental myometrial thickness (1.3 vs. 2.1 mm) were significantly different between the two groups (p < .05). Smallest retroplacental myometrial thickness was a significant predictor for the cases appropriate for successful conservative approach (Area Under Curve, AUC =0.911, p < .001), optimal cut off value was obtained at 1.6 mm with 94% sensitivity and 85% specificity.Conclusions: Our data showed that among some sonographic findings of abnormal placentation, smallest myometrial thickness was a significant predictor to determine candidates for conservative approach.

Leukaemia hijacks a neural mechanism to invade the central nervous system.

Acute lymphoblastic leukaemia (ALL) has a marked propensity to metastasize to the central nervous system (CNS). In contrast to brain metastases from solid tumours, metastases of ALL seldom involve the parenchyma but are isolated to the leptomeninges, which is an infrequent site for carcinomatous invasion. Although metastasis to the CNS occurs across all subtypes of ALL, a unifying mechanism for invasion has not yet been determined. Here we show that ALL cells in the circulation are unable to breach the blood-brain barrier in mice; instead, they migrate into the CNS along vessels that pass directly between vertebral or calvarial bone marrow and the subarachnoid space. The basement membrane of these bridging vessels is enriched in laminin, which is known to coordinate pathfinding of neuronal progenitor cells in the CNS. The laminin receptor α6 integrin is expressed in most cases of ALL. We found that α6 integrin-laminin interactions mediated the migration of ALL cells towards the cerebrospinal fluid in vitro. Mice with ALL xenografts were treated with either a PI3Kδ inhibitor, which decreased α6 integrin expression on ALL cells, or specific α6 integrin-neutralizing antibodies and showed significant reductions in ALL transit along bridging vessels, blast counts in the cerebrospinal fluid and CNS disease symptoms despite minimally decreased bone marrow disease burden. Our data suggest that α6 integrin expression, which is common in ALL, allows cells to use neural migratory pathways to invade the CNS.

Application of MDCTA in free Flow-through anterolateral thigh flap for reconstructing the combined limb soft tissue with main vascular defect

Objective To evaluate the clinical value of MDCTA (Multi-detector computed tomographic angiography) in reconstruction of the soft tissue defect of the limbs combined with the main vascular defects by using Flow-through anterolateral thigh flap. Methods From September, 2013 to May, 2016, 12 cases of limb soft tissue with main vascular defects were examined by MDCTA. The length of vascular defect was measured. The length of bridging vessel needed to design a Flow-through anterolateral thigh flap was measured. The points of anterolateral thigh flap perforator were positioned. The relationship between the perforation and the trunk vascular pedicle was defined. The outcomes were evaluated based on Berton scores for upper extremities and John-Wruh scores for lower extremities. Results The length of the main vascular defects, the positions of flap perforators and the configuration of vascular pedicles were successfully imaged through MDCTA. The length of the main vascular defects were 5-12 cm, which was consistent with the intraoperative findings. The length of bridging vessel for the defects were 7-14 cm, which was enough for the vascular defects. There were not vessel grafts. Twenty perforators were imaged by MDCTA preoperatively, and 22 perforators were found during the operations, which means 2 perforators were not imaged. All flaps survived completely. All patients were followed-up from 6 to 21 months (average, 11 months) . According to the Berton scores for upper extremities and John-Wruh scores for lower extremities, the excellent/good were 6 in 8 cases and 4 in 4 cases, respectively. Conclusion MDCTA can be used to evaluate the pedicle conditions of the free Flow-through anterolateral thigh flap for the reconstructions. It is worthy to be popularized in clinical application. Key words: Anterolateral thigh flap, Flow-through flap; Extremities; Vascular defect; MDCT angiography; Repair

A case of chronic subdural haemorrhage and its medico-legal implication

Subdural haemorrhage is almost always traumatic and rarely natural. Traumatic Subdural haemorrhage (SDH) occurs following break of the parasagittal bridging vessels due to shearing movement of the head. Clinical features appear in 3 days in acute SDH, in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH. SDHs are aged macroscopically and histopathologically. A 42 years old female knocked down by a bus was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. By the next day, almost all symptoms were settled except headache and was discharged. Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. She was transferred to a tertiary care hospital immediately. The pre-op CT scan showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery. She was transferred back to the base hospital and according to the medico-legal examination performed 21 days after the incident, the category of hurt was “fatal in the ordinary course of nature”. In the remarks column, it was mentioned that it is not clear whether this SDH is due to the fall from the bus or any other incident after that. This chronic SDH also could be following a separate “new incident” that took place after the traffic accident. Therefore, without dating the chronic SDH accurately, it is not safe to identify the real causative circumstance.

Unified two-stage fatigue methodology based on a probabilistic damage model applied to structural details

Fatigue cracks are often a result of incremental stable crack growths that can be described by fracture mechanics. Fatigue crack initiation, however, has been most often described using empirical relationships between an alternating stress or strain and the number of cycles at those loads until either a specimen fails or a crack is observed. There are, however, modern views that consider fatigue crack growth and crack initiation directly related phenomena, the former being repeated instances of the latter, localized at an existing crack tip. Models of this newer class allow for an integrated initiation and crack growth calculation process which is advantageous when dealing with notched details in elastoplastic strain conditions. Recently, Huffman developed such a model which relates Walker-like stress-life relation and fatigue crack growth behaviour. This paper expands upon this new approach in order to account for the expected statistical variation using probabilistic S-N and ε-N fields as per works of Castillo and Fernandez-Canteli. A unified local approach proposed to treat fatigue crack initiation and growth is used on notched geometries with the predicted probabilistic variations being accounted. Notched details made of puddle iron from the Eiffel bridge and P355NL1 pressure vessel steel are considered in this study.

OP27.02: “Rail”sign for prediction of advanced AIP (abnormally invasive placenta)

ISUOG published the consensus of ultrasound descriptors for abnormally invasive placenta (AIP) last year. However, these predictors did not distinguish their extents of severity. We retrospectively reviewed those cases of placenta previa totalis with the suspicion of AIP during the period between Feb 2002 and Mar 2017. In these cases, both transabdominal and transvaginal ultrasound were performed. A targeted scanning was directed towards the flow signals between the placenta and bladder mucosa. “Rail” sign indicated two parallel flow signals of subplacental and bladder mucosa region with interconnected bridging vessels perpendicular to them. All these patients received ultrasound examination and operation at our hospital. In this cohort, we have more than 850 cases of persistent placenta previa. Among them, 138 consecutive cases of AIP were confirmed during operation. In addition to those common ultrasound descriptors, we disclosed “rail” sign by colour Doppler in 18 out of 21 cases of placenta percreta, 32 out of 84 of placenta increta and none of the remaining cases of placenta accreta. Among these AIPs with “rail” sign, 8 received complicated subtotal hysterectomy and 42 underwent simple hysterectomy (compared to 52 hysterectomies out of 88 patients without rail sign). Bladder injury occurred in 6 patients with rail sign (compared to none in the remaining cases without rail sign). Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients

Objective: To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients. Methods: From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients' general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm. Results: The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands. Conclusions: The flow-through descending branch of lateral circumflex femoral artery flap can repair wrist wounds and recover blood supply of hands and it is a good method for repairing high-voltage electrical burns of wrist.

Ultrasound Biomicroscopy in Pseudophakic Patients with Unexplained Recurrent Hyphema or Vitreous Hemorrhage

ABSTRACTPurpose: To describe IOL haptic with iris or ciliary body touch on ultrasound biomicroscopy (UBM) in pseudophakic patients with unexplained recurrent hyphema or vitreous hemorrhage. Methods: Retrospective chart review of 10 patients who presented with unexplained recurrent hyphema and or vitreous hemorrhage. Results: There were eight posterior chamber intraocular lenses (PCIOL) and two sulcus lenses. Four cases had a history of glaucoma; two cases which had a history of trabeculectomy were found to have some bridging vessels along the sclerostomy requiring argon laser gonioplasty. No preceding trauma or retinal pathology was found. UBM revealed haptic-ciliary body or haptic-iris touch in cases with a PCIOL and haptic-iris touch in both sulcus lens cases. One case with a PCIOL did not reveal any haptic-iris or ciliary body touch and instead displacement of the optic temporally, though haptics remained intracapsular. Conclusions: UBM is a useful tool to evaluate haptic position in pseudophakic patients with unexplained recurrent hyphema and/or vitreous hemorrhage. This is the largest existing series of patients with this clinical entity reported from a single institution.