Changes In Patient Position Research Articles

A Study on Floor-Deformation Mechanism for Nursing Bed Considering of Patient's Posture and Position Change

A Study on Floor-Deformation Mechanism for Nursing Bed Considering of Patient's Posture and Position Change

Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study

Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common. A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation. In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate. In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.

Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty.

Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP®) has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP surgical tool, which offers an accurate and easy-to-use option for hip surgeons to manage leg length, offset, and cup position intraoperatively.

Descending genicular vessels as recipient pedicle for free flap cover of complex defects around upper and mid-lower third junction of tibia.

Dear Sir, Selection of ideal recipient vessels is one of the most important factors determining success in free-flap reconstruction of the lower limb. For defects at the knee, upper and mid third tibia; the choice of vessels has traditionally been either the common femoral or the popliteal and their branches [1]. The descending genicular artery a branch of the superficial femoral artery, is 1.5– 2 mm in size. It originates approximately 13 cm from knee joint. It passes distally between the sartorius and the vastus medialis [2]. Use of the descending genicular vessels for knee reconstruction was first described in three cases by Park and Eom [3]. More recently, this artery has been used more extensively as a source of vascularised corticoperiosteal grafts from the medial femoral condyle [4]. We hereby present a series of three patients in whom descending genicular vessels were used as a reliable recipient for free flaps covering upper and mid-lower third leg defects. All three patients were males in their third decade with motor vehicle accidents. They presented with GIIIB defects of upper & mid-lower third leg. They had significant crush injury which limited the local/ regional options as gastrocnemius muscle was crushed. All three had skin loss with internal degloving of the skin. CTAngiography showed single vessel leg in all three; with sensate foot. Free flap reconstruction was haunted with recipient vessel issues as the popliteal vessel and its branches were often in the zone of trauma and was difficult to access, as it often needed change in patient position. The only options for the recipient vessels in the past with similar injuries were long vein grafts onto superficial femoral artery or arteriovenous (AV) loops; both having their complications. These above mentioned factors posed real reconstructive challenge. This recipient vessel as a choice acted as a life boat in saving limbs. All patients had initial fracture stabilisation with external fixation followed by internal fixation and free latissimus dorsi muscle flap cover. Entire procedure was performed in lateral position enabling a two team approach of simultaneous flap harvest and recipient vessel preparation. Split skin graft was applied over the free latissimus dorsi muscle in the same setting (Fig. 1 depicting case 1). All patients recovered well with uneventful post-operative course and had normal gait within 6 months period. Thus the use of the descending genicular artery as recipient vessel has various advantages including: (i) its remote from the zone of trauma, (ii) constant in location, (iii) excellent size match for end-to-end anastomosis, (v) simultaneous two team approach, (vi) it obviates the need of AV loops and the complexity associated with vein grafts. To the best of our knowledge this is the only * Chandan Jadhav chandansurgery@gmail.com

Pressure ulcers and support surfaces

In health area pressure ulcers remain until today a major problem, especially in critically ill patients in whom the incidence is increasing due to their prolonged detention. An important part in the appearance of pressure sores is prevention. Prevention can be achieved in several ways such as by changing patient position or using specialized support surfaces which reduce the pressure in the areas most commonly created the pressure sores. Equally important part in pressure sores problem is manage the problem and it can mainly achieved by the use of specific pads or the use of new, alternative methods to help them heal faster. The support surface is a specialized pressure redistribution device (pressure redistribution) which is designed to support tissue, and/or other therapeutic functions. The optimal supportive surface relieves the pressure, the fragmentation and friction and maintains a constant temperature in the human body. Such a supportive surface redistributes body weight on a possibly largest surface of the body, thereby reducing the pressure at specific parts of the body and therefore tissue damage is prevented.

Changing Patient Position Can Eliminate Arrhythmias Developing During Extracorporeal Shockwave Lithotripsy.

Extracorporeal shockwave lithotripsy (SWL) has a low complication rate. While serious complications are rare, cardiac arrhythmias, such as ventricular tachycardia, may occur. The etiology of these arrhythmias is poorly understood, but it appears to be due to stimulation of the heart by the shock waves. This study examines the effect of rotating the patient 15° to 20° when an arrhythmia occurs. Eight hundred nineteen patients were prospectively evaluated for arrhythmias during SWL. The initial patient position was dependent on the location of the stone and the body mass index (BMI) of the patient. If a sustained arrhythmia developed, treatment was withheld for 2 minutes and then recommenced. If the patient developed an arrhythmia again, the patient was rotated 15°-20° away from the original position and treatment recommenced. Twenty patients developed significant arrhythmias during SWL. Arrhythmias occurred more frequently in patients with a lower BMI (p < 0.01), of younger age (p = 0.01), and with right-sided stones (p = 0.035). After the first rotation, 11 patients had no further arrhythmias, and 4 patients had a reduction of their arrhythmia to unsustained minor arrhythmias that did not require cessation of the treatment. The remaining five patients required a second repositioning. Three of these patients required gated SWL to abolish the arrhythmia. Changing the position of the patient by rotating the patient by 15 to 20° can eliminate arrhythmias that develop during SWL.

Change in Image Quality According to the 3D Locations of a CBCT Phantom.

A patient’s position changes in every CBCT scan despite patient alignment protocols. However, there have been studies to determine image quality differences when an object is located at the center of the field of view (FOV). To evaluate changes in the image quality of the CBCT scan according to different object positions, the image quality indexes of the Alphard 3030 (Alphard Roentgen Ind., Ltd., Kyoto, Japan) and the Rayscan Symphony (RAY Ind., Ltd., Suwon, Korea) were measured using the Quart DVT_AP phantom at the center of the FOV and 6 peripheral positions under four types of exposure conditions. Anterior, posterior, right, left, upper, and lower positions 1 cm offset from the center of the FOV were used for the peripheral positions. We evaluated and compared the voxel size, homogeneity, contrast to noise ratio (CNR), and the 10% point of the modulation transfer function (MTF10%) of the center and periphery. Because the voxel size, which is determined by the Nyquist frequency, was within tolerance, other image quality indexes were not influenced by the voxel size. For the CNR, homogeneity, and MTF10%, there were peripheral positions which showed considerable differences with statistical significance. The average difference between the center and periphery was up to 31.27% (CNR), 70.49% (homogeneity), and 13.64% (MTF10%). Homogeneity was under tolerance at some of the peripheral locations. Because the CNR, homogeneity, and MTF10% were significantly affected by positional changes of the phantom, an object’s position can influence the interpretation of follow up CBCT images. Therefore, efforts to locate the object in the same position are important.

Comparison of Two Pain Assessment Tools, "Facial Expression" and "Critical Care Pain Observation Tool" in Intubated Patients After Cardiac Surgery.

Background:Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation.Objectives:This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were “critical-care pain observation tool (CPOT)” and “facial expression (FE)”.Patients and Methods:This was a prospective study based on diagnostic test evaluation. A sample of 91 intubated patients was selected from cardiac post-anesthesia care unit. Collected data were demographic characteristics, vital signs, FE and CPOT tools’ scale. Pain was assessed with CPOT and FE scores five times. The first assessment was performed in at least 3 hours after admission of patients to ICU. Then, the pain intensity was reassessed every 30 minutes. In addition, blood pressure, heart rate, respiratory rate and oxygen saturation were measured simultaneously.Results:At the first period, the frequency of “severe” pain intensity using the CPOT was 58.2% and with the FE tool was 67% (P = 0.001). Both tools demonstrated reduction in severity of pain on second and third assessment times. Significantly increasing level of pain and blood pressure due to nursing painful procedures (endo-tracheal suctioning, changing patient’s position, etc.), were obtained by CPOT in fourth assessment. FE was not able to detect such important findings (κ = 0.249). In the fifth step, pain intensity was reduced. The most agreement between the two tools was observed when the reported pain was “severe” (κ = 0.787, P < 0.001) and “mild” (κ = 0.851, P < 0.001).Conclusions:The sensitivity of CPOT was higher for detection and evaluation of pain in intubated postoperative patients compared with “Facial Expression”. Best agreement between these tools was observed in two extremes of pain intensity.

Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report.

Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position.

Seeing better--Evidence based recommendations on optimizing colonoscopy adenoma detection rate.

Colorectal cancer is one of the three most frequent causes of cancer deaths in men and women in Europe and North America. Diagnosis and resection of adenomas has convincingly demonstrated its utility in diminishing colorectal cancer incidence. Therefore, colonoscopy is now the gold standard for colorectal cancer screening. But it is also known that colonoscopy effectiveness varies among endoscopists. Among different quality indicators, the most used is the adenoma detection rate (ADR) which is the percentage of average-risk patients for colorectal cancer who are found to have at least one adenoma or adenocarcinoma during a screening colonoscopy. There is compelling evidence supporting an inverse correlation between ADR and interval colorectal cancer (cancer found after a screening colonoscopy). Many factors such as quality of precolonoscopy preparation, additional observers, manoeuvres with the endoscope (second view, retroflexion, water inflation rather than air), time spent during withdrawal, changes in patient position, fold-flattener devices, new imaging or endoscopic modalities and use of intravenous or through the scope sprayed drugs, have been studied and developed with the aim of increasing the ADR. This reviews discusses these factors, and the current evidence, to "see better" in the colon and optimize ADR.

Wrong-site regional anesthesia: review and recommendations for prevention?

Wrong-site regional anesthetic procedures are considered never events. The purpose of this review is to describe the phenomenon of wrong-site regional anesthetic blocks and identify preventive strategies. The incidence of wrong-site block may be as frequent as 7.5 per 10,000 procedures. Factors contributing to wrong-site block include physician distraction, patient position change, scheduling changes, inadequate documentation, poor communication, lack of surgical consent, site marking not visible, inadequate supervision, reduced situational awareness, fatigue, cognitive overload, perceived time pressure, delay from World Health sign-in to block performance and omission of block time-out or block time-out occurring before final patient positioning. The American Society of Regional Anesthesia and Pain Medicine have created a 9-point checklist for regional anesthesia procedures. Preoperative site verification and surgical site marking are mandatory. A time-out should occur immediately before any invasive procedure. Confirming the correct patient and block site with a time-out should occur immediately before all regional anesthetic procedures. If more than one block is performed on one patient, it is recommended that time-out be repeated each time the patient position is changed or separated in time or performed by a different team. The anesthetic team should uniformly implement robust guidelines and checklists to reduce the occurrence of wrong-site regional anesthetic procedures.

Randomized-Controlled Trial Comparing Adenoma Detection Rate Using Water Exchange Versus Air Insufflation Colonoscopy in a U.S. Community-Based Setting

Introduction: Efforts are underway to improve adenoma detection rate during screening colonoscopies, especially in the right colon. Water exchange colonoscopy has demonstrated promising results, purportedly by better cleansing of the colon, and has also resulted in less patient discomfort. Majority of these studies were conducted in a predominantly male and Caucasian VA population. We report the first community-based RCT in the USA that includes female and minority populations, comparing water exchange with air insufflation method in assessing adenoma detection rate. Methods: A prospective sample of 178 patients above 50 years of age presenting for screening and surveillance colonoscopies at a community-based endoscopy center, with no personal or family history of colon cancer, familial polyposis syndromes, inflammatory bowel disease, or prior history of colonic surgery, who consented for the study were blinded and randomized to either water exchange (n=88) or air insufflation colonoscopy (n=88). Four endoscopists participated in the trial. All patients received adequate sedation prior to scope insertion, followed by sequential doses as needed. All patient received a split bowel prep. Prep quality was assessed by the Boston Bowel Prep Score. Post-procedure pain and recovery time were assessed by a nurse blinded to the colonoscopy technique. All colon polyps were assessed by expert GI pathologists. Sessile serrated lesions were reported when found. Advanced adenomas were defined as villous or tubulovillous in histology, or size > 1 cm. Adenomas found proximal to splenic flexure were reported as proximal adenomas. Results: Of 178 patients, 3 were excluded from final analysis, 1 in the air group diagnosed with FAP, and 2 in the water group requiring switch to pediatric colonoscopes due to tortuous sigmoids. There were no statistically significant differences between the 2 groups in terms of sex, race (Caucasian, Black, Hispanic, Asian), age, BMI, alcohol and tobacco use, bowel prep quality, sedation requirement, abdominal pressure application, patient position change, endoscope stiffner use, or scope length at cecum. The cecum was intubated in all patients. Conclusion: Water exchange colonoscopy is a viable technique in a busy community-based endoscopy center. It demonstrated a trend towards higher polyp, adenoma, sessile serrated lesion and advanced adenoma detections. It resulted in significantly lower post procedure pain and recovery time, without significantly increasing procedure time.Table 1: Baseline patient characteristicsTable 2: Polyp detection rates, procedure and recovery times, and post procedure pain

SU‐E‐J‐195: Evaluation of a Camera‐Based External Patient Position Tracking System

Purpose:To evaluate the accuracy of a camera‐based patient external position monitoring system optimized for localized patient movements.Methods:A prototype software application implements a template‐based tracking algorithm. The application generates templates located at strategic points on the patient's anatomy as seen in an acquired initial video image frame. For subsequent frames, the template pattern is matched in a userdefined region around those points using cross‐correlation, and the match is used to determine the local motion at those points.A motion stage was used to move a fabric sample (representing patient's clothing) to various positions around a 20 by 20 mm space. An optical camera, at 1.5 m distance, monitored the movement of the sample. At each sample position, the software application evaluated the displacement from initial position based on the camera image; results were compared to the known motion stage displacements.A motorized breathing manikin was set up on a treatment machine couch. The same optical camera was positioned so as to monitor both breathing and random motion of the manikin in simulation of a clinical treatment scenario. Setups for both torso tracking (respiratory) and face tracking (stereotactic head) conditions were simulated and measured for precision and accuracy.Results:On the motion stage, calibrated tracking accuracy and precision were both consistently better than 0.5 mm in both vertical and lateral axes. Similar results were achieved for the manikin motion in the clinical simulations.Conclusion:Localized camera‐based tracking is capable of monitoring external changes in patient position to submillimeter level. While not able to track internal tumor motion directly, such a system would nonetheless be able to detect tiny movements of the body, bumps, and respiratory motion, any of which may signal a need to check the position of the tumor.All work funded by Varian Medical Systems Inc.

Variation in patient position and impact on carbon-ion scanning beam distribution during prostate treatment.

We assessed the impact of changes in patient position on carbon-ion scanning beam distribution during treatment for prostate cancer. 68 patients were selected. Carbon-ion scanning dose was calculated. Two different planning target volumes (PTVs) were defined: PTV1 was the clinical target volume plus a set-up margin for the anterior/lateral sides and posterior side, while PTV2 was the same as PTV1 minus the posterior side. Total prescribed doses of 34.4 Gy [relative biological effectiveness (RBE)] and 17.2 Gy (RBE) were given to PTV1 and PTV2, respectively. To estimate the influence of geometric variations on dose distribution, the dose was recalculated on the rigidly shifted single planning CT based on two dimensional-three dimensional rigid registration of the orthogonal radiographs before and after treatment for the fraction of maximum positional changes. Intrafractional patient positional change values averaged over all patients throughout the treatment course were less than the target registration error = 2.00 mm and angular error = 1.27°. However, these maximum positional errors did not occur in all 12 treatment fractions. Even though large positional changes occurred during irradiation in all treatment fractions, lowest dose encompassing 95% of the target (D95)-PTV1 was >98% of the prescribed dose. Intrafractional patient positional changes occurred during treatment beam irradiation and degraded carbon-ion beam dose distribution. Our evaluation did not consider non-rigid deformations, however, dose distribution was still within clinically acceptable levels. Inter- and intrafractional changes did not affect carbon-ion beam prostate treatment accuracy.

How to Reduce Bilateral Cervical Facet Joint Dislocation in Anterior Approach: A Trick to Avoid Anterior-Posterior-Anterior Surgical Procedures

Introduction Cervical facet joint dislocation is a common injury of the lower cervical spine. These flexion distraction lesions in cervical spine occur as a subluxation or unilateral/bilateral dislocation of the facet joints, which often be accompanied by direct spinal cord and nerve root injury. The presence of herniated intervertebral disc requires an anterior approach to decompress the spinal cord. Because often it is not possible to reduce facet joint dislocation while performing anterior surgery an additional posterior approach and then the fixation trough an anterior approach again is necessary. This method (supine-prone-supine) creates difficulties for surgeons because of the prolonged operation time; the need for frequent changes in patient position; and a subsequent high incidence of complications. Materials and Methods On the basis of a case, we present a maneuver to use pins such as joysticks in vertebral body during anterior approach to reduce dislocated facet joints in cervical spine fractures. After cervical discectomy/corpectomy, we use the pins to put the vertebral body in kyphotic position following rotational motion to reduce the facet joints. Results and Conclusion: Since we implemented this procedure, we had no more to perform posterior approach in surgical treatment in the last 15 cases of bilateral facet joint dislocation with herniated intervertebral disc in cervical trauma.

Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial

It has been suggested that changing patient position during colonoscope withdrawal increases adenoma detection. The results of previous studies have been conflicting. To evaluate whether routine position change during colonoscope withdrawal improves polyp detection. Randomized, 2-way, crossover study. Teaching hospital. A total of 130 patients attending for diagnostic colonoscopy. Patients undergoing colonoscopy had each colon segment examined twice: the right side of the colon (cecum to hepatic flexure) in the supine and left lateral position and the left side of the colon (splenic flexure and descending colon) in the supine and right lateral position. The transverse colon was examined twice in the supine position. The primary outcome measure was the polyp detection rate (≥1 polyp) per colon segment. Secondary outcome measures included the number and proportion of patients with ≥1 adenoma in each segment and adequacy of luminal distension (1 = total collapse and 5 = no collapse). Examination of the right side of the colon in the left lateral position significantly improved polyp detection (26.2% vs 17.7%; P = .01) and luminal distension (mean = 4.0 vs 3.5; P < .0001). Position change did not improve polyp detection in the left side of the colon (5.4% vs 4.6%; P = .99). There was no significant correlation between luminal distension and polyp detection in the right side of the colon (r = .03). Single center and open study design. Examining the right side of the colon in the left lateral position increased polyp detection compared with examination in the supine position. Polyp detection in the left side of the colon was similar in the right lateral and supine positions. ( NCT01554098.).

PD13-08 CHANGING PATIENT POSITION CAN ELIMINATE ARRHYTHMIAS DEVELOPING DURING SHOCK WAVE LITHOTRIPSY (SWL)

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2015PD13-08 CHANGING PATIENT POSITION CAN ELIMINATE ARRHYTHMIAS DEVELOPING DURING SHOCK WAVE LITHOTRIPSY (SWL) Tarek Alzahrani, Daniela Ghiculete, Kenneth Pace, and R.J. D'A. Honey Tarek AlzahraniTarek Alzahrani More articles by this author , Daniela GhiculeteDaniela Ghiculete More articles by this author , Kenneth PaceKenneth Pace More articles by this author , and R.J. D'A. HoneyR.J. D'A. Honey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1072AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES SWL has a low complication rate. While serious side effects are rare arrhythmias such as ventricular tachycardia may occur and require cessation of treatment. The etiology of these arrhythmias is poorly understood, but is most likely related to the relative position of the stone and the heart. This study examines the effect of rotating the patient 15 to 20 degrees when an arrhythmia occurs. METHODS 1369 patients were prospectively evaluated for arrhythmias during SWL. The initial patient position was dependent on the location of the stone and the size of the patient. Stones on either side may be treated with the patient flat supine. More frequently, the patients are rotated about 15 degrees with the opposite side to the stone elevated. With stones on the right the patient would be right posterior oblique (RPO) and for left sided stones left posterior oblique (LPO). If a sustained arrhythmia developed, treatment was held for 2 minutes and then recommenced. If the arrhythmia returned, as occurred in all 20 patients, the patient was rotated to the flat, RPO or LPO position, angling the shock wave away from the heart. RESULTS 20 patients developed significant arrhythmias during SWL. Arrhythmias occurred more frequently in patients with a lower BMI (P<0.01) and in those with right-sided stones (P=0.035). After rotation no further arrhythmias were seen in 13 patients. Gated ESWL was only needed in only 3 of the 20 patients after changing their position. CONCLUSIONS Changing the position of the patient by rotating the patient by 15 to 20 degrees may eliminate arrhythmias that develop during SWL allowing the continuation of the SWL treatment without the need to perform a gated SWL. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e264-e265 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Alzahrani More articles by this author Daniela Ghiculete More articles by this author Kenneth Pace More articles by this author R.J. D'A. Honey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Water-Assisted Colonoscopy

Water-Assisted Colonoscopy

The formation of the latissimus dorsi muscle flap in the dorsal decubitus position

DOI: 10.5935/2177-1235.2015RBCP0138 Institution: Hospital Universitario da Universidade Federal de Alagoas (HU/UFAL), Maceio, AL, Brazil. Introduction: The latissimus dorsi muscle is located on the lateral-posterior chest wall. The latissimus dorsi muscle flap (LDMF) has extensive applications due to its consistent anatomy, which contributes to its use in plastic surgery. This muscle can be dissected in the dorsal decubitus (DD) position; this removes the need for a change in patient position and enables microsurgical reconstruction to be performed. This study aimed to describe the technique used for the dissection and transfer of the LDMF in the DD position. Methods: We evaluated 10 cases of LDMF formation performed in the University Hospital of the Federal University of Alagoas. The surgical procedures of individualization of the flaps and their positioning in the receiver region were similar in all ten cases. The evaluation of the muscle and the demarcation of the flap were performed with the patient in the standing position. Then, with the patient in the DD position, anesthetic induction was initiated and the operating field prepared. The neurovascular pedicle was formed by incising the top edge of the ellipse that delimits the LDMF, dissecting the insertion tendon of the muscle, and removing the flap necessary for the reconstruction of the receiver area. Results: The patient was in the DD position during the intraoperative period, even during the dissection of muscle flaps, and the technique used had no surgical disadvantages. Conclusion: It is possible to perform the dissection and individualization of the LDMF with the patient in the DD position. ■ ABSTRACT

Visualization Balloon Allows Successful Performance of Colonoscopy in Patients With Prior Documented Difficult Colon Anatomy: A Pilot Clinical Study

Introduction: Traditional colonoscopy with air or carbon dioxide (CO2) insufflation can be difficult in patients with long, redundant, and torturous colons. Insufflation of gas lengthens the colon and makes colonoscope navigation towards the cecum difficult and sometimes even impossible. A proprietary visualization balloon, (Vizballoon™) was recently introduced into clinical practice in the USA. Use of Vizballoon ™ eliminates the need for air or CO2 insufflation and facilitates advancement of the colonoscope through the colon. Methods: We performed Vizballoon™-assisted colonoscopies in patients with documented previous difficult colonoscopies. Prior to the start of the procedure, Vizballoon™ was inserted through the biopsy channel of adult colonoscope (CF 190, Olympus, Tokyo, Japan) and filled with 5 ml of water. Then the colonoscope with Vizballoon™ was inserted into the rectum and advanced without any gas insufflation until the cecum was reached. At this point the water was aspirated from the balloon and the Vizballoon™ was removed. The.CO2 was insufflated to optimize visualization of the colonic lumen during withdrawal of th Vizballoon™ e colonoscope. Results: Vizballoon™-assisted colonoscopies were performed in 4 consecutive patients with known previous difficult colonoscopies, performed in the past with CO2 insufflation. Previous colonoscopies in these patients required significant amount of external pressure and changes in patient position in order to reach the cecum. Technical difficulties during prior colonoscopies were caused by long, redundant colons (2 patients), and torturous colons with diverticuli and multiple fixed turns (2 patients). In all study patients the colonoscope with Vizballoon™ was easily advanced to the cecum (within 3.75-12 minutes) without any external pressure or change in patient position None of the study patients had any abdominal discomfort after colonoscopy. Conclusion: In patients with documented difficult colonic anatomy, use of the visualization balloon eliminates the need for gas insufflation during advancement to the cecum,. Balloon assistance makes colonoscopy technically easier, faster, and increases the likelihood of successfully reaching the cecum without the application of external pressure or change in patient position.