Dorsal Artery Research Articles

Dorsal pancreatic artery: incidence, morphometry, origin, course, branches

Dorsal pancreatic artery: incidence, morphometry, origin, course, branches

Comparação da monitorização invasiva e não invasiva da pressão arterial em Cuniculus paca (Paca)

Cuniculus paca, a South American wild rodent with zootechnical potential, requires anesthesia for management procedures. However, limited information is available regarding safe monitoring of this animal under anesthesia. This study aimed to compare with gold standard invasive method and validate non-invasive blood pressure measurements using an oscillometric monitor in Cuniculus paca. Eight healthy adult females undergoing general anesthesia for follicular aspiration were included. Systolic, diastolic, and mean arterial pressures were measured simultaneous using, oscillometric non-invasive monitor with its cuff placed on the radial artery and an invasive catheter placed in the dorsal metatarsal artery. Measurements were compared using the t-test, correlated by Pearson test, and analyzed using the Bland-Altman concordance test. The results indicated that only systolic pressure measured by non-invasive oscillometric methos was similar to the pressure measurement by invasive method (P=0.6372, r=0.5969, bias 0.59±20.9 mmHg); while mean and diastolic pressures were underestimated by the non-invasive method. In conclusion, non-invasive oscillometric monitor provides a valid and reliable method for systolic blood pressure measurement in Cuniculus paca under general anesthesia.

The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction-A Systematic Review.

When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted. A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years. This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.

The resistive and pulsatility indices of the dorsal metatarsal artery for the screening of peripheral lower artery disease in patients with and without diabetes

BackgroundIn lower extremity peripheral artery disease (PAD), the ankle-brachial index (ABI) is an easily reproducible diagnostic tool for PAD, but it loses reliability when > 1.4 due to calcification of the vessel wall. Patients with diabetes are at higher risk for wall calcification. In order to overcome the limitation and reliability of ABI, particularly in patients with diabetes, we decided to assess resistive (RI) and pulsatility index (PI) by ultrasound doppler of the dorsal metatarsal artery (DMA). ResultsWe therefore analyzed 51 legs (32 patients), evaluating the correlation between PI, RI, and ABI. Patients with diabetes were 21 (65.6 %), accounting for 33 legs (64.7 %). Out of 51 legs assessed, 37 (72.5 %) cases had compressible arteries, whereas in 14 legs (27.5 %) ABI was not calculable due to wall calcification. PAD was significantly associated with lower both RI and PI of the DMA (both p < 0.000). RI, but not PI, showed a significant correlation (r = 0.535) with ABI, when ABI was less than 1.4, but not when ABI > 1.4. When analyzed separately, patients with diabetes showed a similar figure in comparison with those without diabetes (r = 0.600), RI, but not PI, showed a significant correlation with ABI. ConclusionDorsal metatarsal artery resistive index (MARI) showed a significant inverse correlation with PAD, similarly to ABI, irrespective of the presence of diabetes. MARI seems to be an effective screening tool for PAD even in patients with wall calcification. Further studies are needed for confirming the results of the present pilot study.

Dorsal Penile Artery Avulsion After Collagenase Clostridium histolyticum (Xiaflex) for Peyronie’s Disease: A Case Report

Collagenase Clostridium histolyticum (CCH) is frequently used as first-line therapy for patients with Peyronie’s disease. It was United States Food and Drug Administration approved in 2013 and since then, has been widely accepted as a safe and effective treatment option with most adverse effects being minor and amenable to conservative management. We report an unusual and previously unreported complication after CCH (Xiaflex) injection: avulsion of a dorsal penile artery, which required surgical exploration and ligation. This article seeks to inform urologists about an unexpected complication that should be considered in the differential diagnosis for severe penile hematoma after CCH injection and discusses our strategy for surgical management.

The dominance of dorsal scapular artery as the blood supply to muscles of the back in the absence of two primary vessels: a cadaveric case report

PurposeUnderstanding of rare or unknown anatomical variations of the vasculature of the neck is critical to reduce the risk of complications during surgeries and other invasive procedures in the neck and shoulder regions.MethodsBilateral dissection of the neck and muscles of the back of an 87-year-old Caucasian male donor was performed to demonstrate the origin, course and termination of the arteries that arise in the neck.ResultsSeveral anatomical variations were noted on the right side of the neck of the donor body – (i) only inferior thyroid and ascending cervical arteries originated from the thyrocervical trunk (TCT), from the first part of the subclavian artery (SA), whereas the transverse cervical (TCA) and suprascapular (SSA) arteries were entirely absent, (ii) Dorsal scapular artery (DSA) emerged normally from the third part of the SA. However, after supplying the rhomboids and levator scapulae muscles, DSA provided two additional branches to the trapezius muscle and a branch to the supraspinatus muscle. Interestingly, the branches to the trapezius muscle from the DSA were the only sources of blood supply to the muscle.ConclusionWe report a unique anatomical variation involving the absence of the TCA and SSA from the TCT. The unilateral absence of these major vessels and the branches of DSA supplying the trapezius and supraspinatus muscles have not been reported previously in the literature in a single case report. This case study may provide useful information for head and neck reconstruction and shoulder repair surgeries.

Stem cell therapy outcome for diabetic erectile dysfunction: A pilot analysis

Background Many males encounter the condition of erectile dysfunction (ED), particularly individuals diagnosed with type 2 diabetes mellitus (DM). Stem cell therapy is a burgeoning treatment modality being explored for individuals with erectile dysfunction in the context of type 2 DM. Nevertheless, the available body of clinical evidence supporting its efficacy remains limited. This study aims to assess the effectiveness and safety of umbilical cord-derived mesenchymal stem cell (MSC) therapy in managing erectile dysfunction (ED) resulting from type 2 DM. Methods A randomized, double-blind, placebo-controlled trial was conducted at Dr. Cipto Mangunkusumo Hospital in Indonesia from October 2020 to January 2023. A total of 26 eligible patients were randomly assigned to two groups: one receiving intracavernosal injections of MSC and the other receiving a placebo. Follow-up assessments were conducted at baseline, month one, and month three. The primary outcomes were measured using the IIEF-5 questionnaire and dorsal artery peak systolic velocity (PSV). Metabolic markers were used as secondary outcomes. Results The IIEF-5 scores for both groups showed a significant increase (p &lt; 0.001) from baseline to month three. There was no significant difference observed between the MSC and placebo groups. Moreover, no significant differences were observed in the PSV of the dorsal artery between the two groups (p&gt;0.05). There were no significant differences in metabolic markers between the groups. The incidence of mild post-injection pain was reported by only 11% of individuals, indicating a low occurrence of adverse events. Conclusions Intracavernous administration of MSC did not demonstrate superior efficacy compared to a placebo in improving metabolic or erectile function in diabetic males with erectile dysfunction. Additional research utilizing larger sample sizes and more extended follow-up periods is necessary.

Combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of a mid-distal adjacent finger defect: a retrospective study

PurposeAssessing the clinical effectiveness of combining with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold to repair mid-distal defects in adjacent fingers.MethodsFrom September 2012 to April 2022, 21 patients with 42 mid-distal defects of adjacent fingers underwent treatment using combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold. The flaps size ranged from 2.1 cm * 1.6 to 4.9 cm * 3.2 cm. Follow-up evaluations included assessing function, sensation, and appearance, etc. of the injured fingers and donor areas.ResultsAll 42 flaps survived in 21 patients without any vascular crises, and the wounds healed in phase I. The mean follow-up time was 12.2 months (range 7–22 months). During follow-up, in injured fingers, according to the Michigan Hand Outcomes Questionnaire (MHOQ), the functional recovery and appearance were satisfactory; in Dargan Function Evaluation (DFE), the results were both “excellent” in fourteen patients, “excellent” and “good” in five patients, both “good” in one patient, “good” and “general” in one. In static two-point discrimination (2PD), the variation ranges from 4 to 9 mm in injured fingers and 6—10 mm in donor toes. Cold Intolerance Severity Score (CISS) is mild in all patients. The visual analogue score (VAS) showed no pain in the injured fingers and donor toes. No deformities or other complications were noted at the donor toes. According to Chinese Manchester Foot Pain and Disability Index (C-MFPDI), there was no morbidity on foot function in all donor areas.ConclusionThe surgical procedure of combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of mid-distal adjacent fingers defect is highly satisfactory. This approach helps the injured fingers to achieve good function, sensibility and appearance, while also achieving satisfactory results in the donor toes.

In the Loop: Endovascular Pedal Arch Revascularization

Advanced endovascular techniques are increasingly being utilized to treat patients with peripheral arterial disease and chronic limb threatening ischemia to improve lower extremity arterial perfusion. In diabetic patients pedal arch patency has been associated with improved wound healing, limb salvage and overall survival. Pedal-plantar loop revascularization is a technique that can restore arterial inflow between the dorsal and plantar arteries of the foot. This article will describe the inframallelolar arterial anatomy and focus on imaging, percutaneous endovascular techniques and clinical study outcomes of pedal artery interventions.

Arterial highways of the foot of the American raccoon (Procyon lotor)

The vascular system is one of the integrating systems of the human and animal body. The course and branching of the vessels of various areas of the body follows general patterns. However, the variability of the vascular bed is quite high even within a single species of animal. The lack of data on both the topography and the peculiarities of arterial branching makes it difficult to carry out diagnostic and therapeutic manipulations. In addition, the data obtained during the study significantly enrich the available information on the comparative anatomy of the vascular bed. The purpose of the study is to study the main arterial arteries of the American raccoon foot area, to give them a morphometric characteristic. The research was carried out on 4 corpses of an American raccoon, delivered to the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine from veterinary clinics. Classical methods were chosen as research methods: fine anatomical dissection, morphometry, photographing and vasorentgenography. During the study, it was found that two arterial highways are distinguished on the foot of the American raccoon. The dorsal trunk is represented by the dorsal artery of the foot, the plantar trunk is represented by the middle plantar artery. The dorsal artery of the foot passes into the arc artery – the first anastomosis that unites the vessels of the two highways. The middle plantar artery gives rise to the second and third plantar metatarsal arteries and participates in the formation of a deep plantar arch, which is the second major anastomosis of the foot area. Axial and non-axial finger arteries also form collateral blood flow. Analyzing the obtained morphometric data of arterial highways, it follows to conclude that the plantar surface highways have the largest diameter. Thus, the diameter of the middle plantar artery is 1.72 times higher than the same parameter of the dorsal artery of the foot. The largest total diameter is characteristic of the arteries located in the metatarsal region, the smallest in the area of the metatarsal.

Preservation of 1st Metatarsal Head Blood Supply with Minimally Invasive Chevron vs Transverse Osteotomy

Introduction/Purpose: The purpose of this study is to evaluate damage to the first dorsal metatarsal artery, first plantar metatarsal artery, and the superficial branch of the medial plantar artery after different types of minimally invasive osteotomies are performed on cadaveric specimen. Methods: 10 cadaveric feet were injected with methylene blue dye to aid in visualizing the vessels. We then randomly divided the samples into 2 groups of 5. Group A received a chevron osteotomy and group B received a transverse cut osteotomy. We then dissected the specimen and studied the damage to the first metatarsal head vascular plexus and recorded the distance of our cuts from the center of the metatarsal head. We plan to take 6 additional cadaveric feet and inject them with silicone based dye prior to performing osteotomies on these additional specimen; 3 chevron and 3 transverse. We will then dissect these specimen in a similar manner to evaluate for vascular plexus damage. We believe this will improve our scientific process. Results: After careful dissection we did not find major damage to the vascular plexus in any of the specimen. Please note: we will be continuing this project with additional cadaveric specimen and improved dye techniques. Conclusion: We did not find a difference in vascular risk between MIS transverse and chevron osteotomy techniques. If the primary safe zone guidelines are respected and care is taken to avoid common pitfalls, surgeons can confidently choose between the two constructs without accommodating further AVN risk. Gross Dissection Displaying First Dorsal Metatarsal Artery

The Edwards Acumen IQ system using peripheral arterial catheter-based waveforms to estimate cardiac output is not accurate as compared to thermodilution in dogs.

To assess the agreement between cardiac output (CO) estimated via evaluation of the arterial pressure waveform by a novel monitoring system (Edwards Acumen IQ sensor and HemoSphere Advanced Monitor Platform [HS-IQ]; Edwards LifeSciences) and measured by thermodilution (TD) in anesthetized, normovolemic, and hypovolemic dogs. To assess the agreement between the HS-IQ CO measurements in the radial artery and dorsal metatarsal artery. 8 purpose-bred Beagles. Dogs were placed under general anesthesia. CO was measured via TD and via the HS-IQ at radial and dorsal metatarsal arterial catheters. CO measurements were obtained at 4 time points including normovolemic and multiple hypovolemic states. Paired measurements of CO were evaluated via the method of Bland and Altman with acceptable limits of agreement (LOA) defined as < 30%. A total of 24 (dorsal metatarsal) and 21 (radial) paired measurements were collected in 8 dogs. The overall bias (CI) for comparison of TD to radial arterial HS-IQ CO measurements was -0.09 L/min. LOA and proportional LOA were -2.66 to 2.49 L/min and -140.72% to 104.94%. The overall bias (CI) for comparison of TD to dorsal metatarsal arterial HS-IQ CO measurements was -0.26 L/min. LOA and proportional LOA were -2.76 to 2.24 L/min and -135.96% to 93.25%. The overall proportional error for radial arterial was -17.9% and for dorsal metatarsal was -21.4%. CO measurements with the HS-IQ were easy to obtain but did not produce results within a clinically acceptable range for either measurement site, with a very wide LOA. The CO estimations from the HS-IQ are not appropriate for clinical use at this time.

FETAL ANATOMY OF THE ARTERIES OF THE DORSUM OF THE HAND

Fetal anatomy of the upper extremity in today’s understanding is a set of morphological methods for studying the structure and topography of the structures of its separate areas in human fetuses from the standpoint of the norm and taking into account the forms of individual anatomical variability. Also, in recent decades, microsurgical anatomy has gained intensive development, in particular the hand, which allows studying the structure and topography of small anatomical structures – blood vessels and nerves, muscle tendons, their layer-by-layer relationship in normal anatomical formation, and pathological deviations depending on the needs of microsurgery.The purpose of the study was to fi nd out the sources of blood supply, topography, and branching areas of the arteries of the back of the hand in human fetuses. The study was conducted on the preparations of 18 human fetuses aged from 4 to 10 months using macromicroscopic preparation, injection of arterial vessels, and morphometry.In human fetuses, the arteries of the back of the hand are arranged in two layers. The surface layer of the arterial vessels of the back of the hand, as a rule, is formed by the radial and anterior interosseous arteries, and (or), less often, by the ulnar or posterior interosseous arteries without the formation of arterial arches or nets. The deep layer of the arteries of the back of the hand mostly forms the back carpal arch and is inseparably connected both with the arteries of the superfi cial layer of the back of the hand and with the palmar arterial arches.The arteries of the deep layer of the back part of the hand are mostly (69.5 % of cases) represented by the back arterial arch: 1) radial-i nterosseous; 2) radial-i nterosseous-ulnar; 3) radial- ulnar; in 25 % of observations – with the posterior carpal arterial network. In 5.5 % of cases, the posterior carpal arch or posterior carpal mesh was absent, and duplication of the deep palmar arterial arch was found. Variability of the sources of formation, the degree of development, and the number of dorsal common digital arteries were revealed in human fetuses.Own dorsal digital arteries, except for the arteries of the thumb, as a rule, reach only the level of the middle phalanx of the fi ngers, and then they become thinner, or end in the periosteum or arterial arch-shaped anastomoses of the fi rst interphalangeal joint, or end in the palmar digital arteries, which provide blood supply to the back surface of the distal parts of the fi ngers of the brush.

Recovery of the hibernating cavernosum by penile revascularization

ABSTRACT Objective Chronic ischemia-related cavernous dysfunction is considered irreversible. However, in certain patients, cavernous function appears to recover with penile revascularization. In this study, we investigated a potential cavernous dysfunction reversibility from a clinical perspective. Patients and Methods We involved 93 young patients in the study with arterial erectile dysfunction (ED) (median age: 30 years). Erectile function tests were performed according to the standard operating procedures of the International Society of Sexual Medicine. Among the participants, 63 and 30 displayed pure arteriogenic and mixed vasculogenic (due to both arterial insufficiency and cavernous dysfunction) ED, respectively. Penile revascularization was performed by anastomosing the inferior epigastric artery to the dorsal artery. The ED treatment success was considered from a score of at least 24 on the International Index of Erectile Function-6. Results Our results proved that penile revascularization cured 92.1% and 73.8% of the patients with pure arteriogenic and mixed vasculogenic ED, respectively (Kaplan-Meier method, log-rank test: no significant difference). The required time for curing 50% of the patients was 10.5 and 10.0 months for pure arteriogenic and mixed vasculogenic ED, respectively, indicating no recovery delay in patients with mixed vascular ED. Furthermore, the cavernous dysfunction degree did not influence cavernous function recovery. Conclusion Penile revascularization cured ED in 73.8% of the patients with mixed vasculogenic ED. Cavernous dysfunction appears to be reversible in certain cases. Furthermore, we observed no delay in functional recovery compared to participants with healthy cavernous function. These two discoveries suggest that cavernous function recovery after penile revascularization is similar to the concept of hibernating myocardium in ischemic myocardium. Although cavernous dysfunction is considered irreversible, it could be reversed in multiple cases with blood flow restoration to the cavernous tissue.

Doppler ultrasound is more accurate than pulse oximeter plethysmography in the measurement of systolic arterial pressure from the median caudal artery in anesthetized dogs.

To compare the accuracy of doppler ultrasound (DOP) and pulse oximeter plethysmography (POP) in the measurement of systolic arterial pressure (SAP) to invasive blood pressure (IBP) in anesthetized dogs. 40 client-owned healthy dogs > 10 kg. Dogs were anesthetized for surgical procedures in dorsal recumbency. Invasive blood pressure was measured from a dorsal pedal artery. DOP and POP device probes were placed over the median caudal artery with a flow-occluding cuff for noninvasive blood pressure measurement. Systolic arterial pressure measured by DOP, loss of pulse oximeter plethysmograph (POPL), and return of pulse oximeter plethysmograph (POPR) were compared to SAP measured by IBP. A linear mixed model was used to determine correlation. Bland-Altman analyses were performed to determine bias, SD, and limits of agreement. The accuracy of DOP and POP was compared to IBP across different tensive states. Conditional R2 values for DOP, POPL, and POPR versus IBP were 0.92, 0.85, and 0.87, respectively (all P < .001). The biases for DOP, POPL, and POPR compared to IBP were +7.6 ± 13.1, +3.9 ± 14.4, and +8.6 ± 15.2 mm Hg (bias ± SD), respectively. Limits of agreement (lower, upper) were (-18.1, +33.3), (-24.3, +32.1), and (-21.2, +38.4) mm Hg for DOP, POPL, and POPR, respectively. DOP and POP overestimated SAP during hypotension (SAP < 90 mm Hg), DOP to a lesser magnitude. DOP measured from the median caudal artery may be acceptable for SAP measurement in dorsally recumbent, healthy anesthetized dogs > 10 kg. POP was determined an unacceptable method.

Morphology of the Dorsal Pancreatic Artery and Its Oncological Significance in Pancreatic Cancer.

Although the dorsal pancreatic artery (DPA) is an important artery that supplies the pancreas, its morphology has not been sufficiently studied. We investigated the morphology of the DPA and the progression of pancreatic cancer along this vessel. Overall, 142 patients with pancreatic cancer who underwent surgical resection at Kanazawa University Hospital between 2004 and 2015 were enrolled. We examined the morphology of the DPA using preoperative computed tomography and cancer progression along the DPA using resected specimens. We investigated the anatomical structures surrounding the DPA through cadaveric examination. The analysis of computed tomography images revealed the presence of the DPA in 141 patients. In typical cases, the DPA divides into a head and a body branch. Histopathological examination revealed cancer progression along the DPA in 32 patients. Cancer progression along the DPA was identified as a factor associated with a poor prognosis in pancreatic head or body cancer. Cadaveric examination showed the presence of abundant nerve and lymphatic tissues along the DPA. It is important to remove the soft tissue surrounding the DPA during surgery for pancreatic head or body cancer because it may serve as an important route for cancer progression.

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia.

Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients. ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.

(128) Penile Replantation in Patient with Klingsor Syndrome; Case Report and Review of Literature

Abstract Introduction Penile amputation has multiple etiologies including self-mutilation, work-related accidents, circumcision, assault motivated by jealousy, rage and feelings of betrayal and animal attacks. By far self –mutilation due to underlying psychiatric disorders (Klingsor Syndrome) are the commonest cause. Re-implantation is the gold standard for management, however it may always not be possible to achieve because of significant local ischemia, tissue damage and prolonged duration post trauma. Objective We are reporting our experience with one case of Klingsor Syndrome and its stepwise management. Methods A 31 years old male Schizophrenic patient self-mutilated his penile shaft due to fixed illusion (get rid of devil in his penis). He also attempted to remove his entire scrotum. His father brought his son with the amputated penile part put in ice. Immediate application of wet saline towel to penile stump and putting of amputated penile part into cold iced saline. Anti-tetanic serum was given together with i.v. antibiotics. Urology team, Plastic microsurgery team together with Psychiatry treating consultant all were emergently called at once. Amputated penile shaft was prepared by the microsurgeon to identify the dorsal artery, vein and nerves and marked by micro-bulldogs. Urology team started by fixation of s.p. cath and preparing, cleaning penile stump. End-to end anastomosis of the urethra was done. Next, the corporal bodies, were reattached using interrupted sutures. Dorsal vein and artery were re-anastomosed microsurgically Results Few days post-operatively skin necrosis started inspite of positive needle brick to the glans indicating healthy underlying glans. Second stage debridement of necrotic skin with later skin grafting resulted in cosmetically and functionally excellent penis regarding erectile and voiding functions Conclusions Penile amputation is a rare surgical emergency mostly found in the literature as isolated case reports. Klingsor syndrome is well known etiology for this type of penile injury and warrants psychiatric control. A multidisciplinary approach involving a urologist, micro-vascular surgeons as well as a psychiatrist ensures good outcome. Microvascular re-implantation remains the treatment of choice with the highest probability of adequate cosmetic as well as functional outcomes Disclosure No.

Spinal cord electrical stimulation with neurophysiological monitoring for treatment of high-risk diabetic foot

To evaluate the clinical efficacy of a single-session implantation of spinal cord electrical stimulation with neurophysiological monitoring a spinal cord electrical stimulator under general anesthesia with neurophysiological monitoring for the treatment of high-risk diabetic foot. The clinical data of seven patients with high-risk diabetic foot who underwent spinal cord electrical stimulation in neurosurgery ward nine of Tianjin Huanhu Hospital from May 2022 to May 2023 were collected. The operation was performed under general anesthesia with the "C" arm X ray machine guidance and neurophysiological monitoring. The arterial diameter and peak flow rate of lower extremity, lower extremity skin temperature (calf skin temperature, foot skin temperature), visual analog scale (VAS), continuous distance of movement, blood glucose level and toe wound were compared between patients before and after surgery. A total of seven patients with high-risk diabetic foot were included. The diameters and peak flow rates of femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery and dorsal foot artery in both lower limbs were significantly improved after surgery. All patients had different degrees of lower limb pain before operation. After operation, VAS score decreased significantly (1.1±0.9 vs. 6.8±3.4), the pain was significantly relieved, and the calf skin temperature and foot skin temperature were significantly higher than those before surgery [calf skin temperature (centigrade): 33.3±0.9 vs. 30.9±0.7, foot skin temperature (centigrade): 31.4±0.8 vs. 29.1±0.6], fasting blood glucose and postprandial blood glucose were significantly lower than those before surgery [fasting blood glucose (mmol/L): 7.6±1.4 vs. 10.5±1.2, postprandial blood glucose (mmol/L): 9.3±2.3 vs. 13.5±1.1], the differences were statistically significant (all P < 0.01). The lower limb movement of all seven patients was significantly improved after surgery, including one patient who needed wheelchair travel before surgery, and one patient who had intermittent claudication before surgery. Among them, one patient needed wheelchair travel and one patient had intermittent claudication before surgery. All patients could walk normally at 2 weeks after operation. Among the seven patients, two patients had the diabetic foot wound ulceration before surgery, which could not heal for a long time. One month after surgery, blood flow around the foot wound recovered and the healing was accelerated. The wound was dry and crusted around the wound, and the wound healed well. For diabetic high-risk foot patients who are intolerant to diabetic peripheral neuralgia and local anesthesia spinal cord electrical stimulation test, one-time implantation of spinal cord electrical stimulator under general anesthesia under neurophysiological monitoring can effectively alleviate peripheral neuralgia and other diabetic foot related symptoms, improve lower limb blood supply, and reduce the risk of toe amputation. Clinical practice has proved the effectiveness of this technique, especially for the early treatment of diabetic high-risk foot patients.

Arterial blood gas measurements are different for brachycephalic and nonbrachycephalic dogs acclimatized to an altitude of 1,535 meters.

To define reference intervals (RIs) for arterial blood gas (aBG) measurements in healthy, nonsedated, dolichocephalic, and mesocephalic (nonbrachycephalic) dogs at approximately 1,535 m above sea level and compare these findings with healthy, nonsedated, brachycephalic dogs living at the same altitude. 120 adult nonbrachycephalic dogs and 20 adult brachycephalic dogs. Cases were prospectively enrolled from October 2021 to June 2022. Dogs were enrolled from the community or after presentation for wellness examinations or minor injuries including lacerations, nail injuries, and lameness. Physical examinations and systolic blood pressure (sBP) measurements were obtained before blood sample collection. Arterial blood was collected from the dorsal pedal artery or femoral artery. After data collection, brachycephalic dogs underwent pre- and postexercise tolerance assessments. The mean and RI values for arterial pH (7.442; 7.375 to 7.515), partial pressure of oxygen in arterial blood (Pao2; 78.3; 59.2 to 92.7 mm Hg), partial pressure of carbon dioxide in arterial blood (Paco2; 28.0; 21.5 to 34.4 mm Hg), saturation of arterial oxygen (Sao2; 98.4; 84.3% to 101.4%), HCO3 (18.9; 14.9 to 22.4 mmol/L), concentration of total hemoglobin (ctHb; 17.5; 13.4 to 21.1 g/dL), and sBP (133; 94 to 180 mm Hg) were established for healthy nonbrachycephalic dogs at 1,535-m altitude. All aBG measurements were statistically and clinically different from those previously reported for dogs at sea level. Brachycephalic dogs had significantly lower Pao2 and Sao2 (P = .0150 and P = .0237, respectively) and significantly higher ctHb (P = .0396) compared to nonbrachycephalic dogs acclimatized to the same altitude; the nonbrachycephalic RIs were not transferable to the brachycephalic dogs for Pao2. This study represents the first collation of aBG measurements for healthy nonbrachycephalic dogs acclimatized to an altitude of 1,535 m. Additionally, this study identified differences in arterial oxygenation measurements between brachycephalic and nonbrachycephalic dogs. RIs in brachycephalic dogs need to be established.