Longitudinal Skin Incision Research Articles

The effects of intrathecal administration of an antagonist for prostaglandin E receptor subtype EP(1) on mechanical and thermal hyperalgesia in a rat model of postoperative pain.

Despite substantial advances in understanding acute pain mechanisms and in the treatment of pain, postoperative pain, especially mechanically evoked pain (incident pain), is generally not effectively treated. Tissue injury and inflammation increase the release of prostaglandin E(2) in the spinal cord, contributing to the development of hyperalgesia. We designed the present study to determine whether the intrathecal administration of an antagonist for prostaglandin E(2) receptor subtype EP(1), ONO-8711, has an analgesic effect on incision-induced mechanical and thermal hyperalgesia. A 1-cm longitudinal skin incision was made in the plantar aspect of the rat foot. The withdrawal threshold to mechanical stimulation and the withdrawal latency to thermal stimulation applied adjacent to the wound of the hindpaw were investigated. Both mechanical and thermal hyperalgesia were observed at 2 h and 24 h after the incision had been made. ONO-8711 (50, 80, 100 micro g) or saline was administered intrathecally. ONO-8711 significantly increased the withdrawal thresholds to mechanical stimulation, but not to thermal stimulation, in a dose- and time-dependent manner. We conclude that EP(1) receptor-mediated sensitization of the spinal dorsal horn may contribute to the generation of mechanical, but not thermal, hyperalgesia and that an EP(1) receptor antagonist administered intrathecally is a potential analgesic for postoperative pain, especially mechanically evoked pain (incident pain). We examined the effects of an intrathecally administered selective EP(1) receptor antagonist on mechanical and thermal hyperalgesia in a postoperative pain model. The intrathecal EP(1) receptor antagonist inhibited the mechanical, but not thermal, hyperalgesia, indicating the potential for an EP(1) receptor antagonist to be used as an analgesic for postoperative pain, especially incident pain.

Volar Surgical Correction of Madelung's Deformity

Volar Surgical Correction of Madelung's Deformity

Spinal N-acetyl-α-linked acidic dipeptidase (NAALADase) inhibition attenuates mechanical allodynia induced by paw carrageenan injection in the rat

N-Acetylated-α-linked acidic dipeptidase (NAALADase) hydrolyzes N-acetyl-aspartyl-glutamate (NAAG) to liberate N-acetyl-aspartate and glutamate. NAAG is a putative neurotransmitter and acts as a mixed agonist/antagonist on N-methyl- d-aspartate (NMDA) receptors and acts as an agonist on the metabotropic glutamate receptor 3 (mGluR3). In the present study, we examined the role of spinal NAALADase in the maintenance of mechanical allodynia induced by carrageenan injection, skin incision and mild thermal injury using 2-(phosphonomethyl)pentanedioic acid (2-PMPA), a specific NAALADase inhibitor, in rats. Mechanical allodynia was induced by injection of 2 mg carrageenan into the paw (carrageenan model), by creating a 1-cm longitudinal skin incision of the plantar aspect of the foot (post-operative model), or by application of thermal stimulation (52.5°C) for 45 s to the hind paw (mild thermal injury model). 2-PMPA was administered intrathecally at the time when the maximum mechanical allodynia occurred. Mechanical allodynia was assessed by the measurement of mechanical threshold using von Frey filaments. The mechanical threshold was measured 5, 15, 30, 60 and 90 min after the drug administration. In the carrageenan model, 100 μg of 2-PMPA attenuated the level of mechanical allodynia. 2-PMPA had no effect on the level of mechanical allodynia in both the post-operative pain model and the mild thermal injury model. These data suggested that the inhibition of spinal NAALADase alleviated mechanical allodynia induced by paw carrageenan injection.

Anti-allodynic effects of oral COX-2 selective inhibitor on postoperative pain in the rat.

To examine the effect of a cyclooxygenase (COX)-2 inhibitor on the maintenance of mechanical allodynia induced by skin incision (an animal model of postoperative incident pain) in the rat. Also, to compare the effect of a COX-2 inhibitor with that of a nonselective COX-1 and COX-2 inhibitor and B2 receptor antagonist. A 1 cm longitudinal skin incision was made in the plantar aspect of the foot. JTE522 (1-100 mg x kg(-1)), a COX-2 inhibitor, indomethacin (1-30 mg x kg(-1)), a nonselective COX-1 and COX-2 inhibitor, or FR173657 (10 and 100 mg x kg(-1)), a bradykinin B2 receptor antagonist, was administered orally five minutes after the end of the surgery. The level of mechanical allodynia was assessed by measuring the frequency of foot withdrawal in response to the application of a 12.5 g on Frey filament at 2, 4, 6, 8 and 24 hr after the drug administration. Oral administration of JTE522 or indomethacin attenuated the maximum response frequency in a dose-dependent manner at a dose between 1 and 30 mg x kg(-1) (P < 0.05). Oral FR 173657, (100 mg x kg(-1)), had no effect on the maximum response frequency. These data indicated that a COX-2 inhibitor attenuated the level of mechanical allodynia in the rat model of postoperative pain.

TAILORED LAMINECTOMY: A NEW TECHNIQUE FOR NEUROMODULATOR IMPLANTATION

Neuromodulation of sacral roots is an alternative mode of therapy for patients with urge incontinence or detrusor hypocontractility. We investigated the effects of sacral (S3) nerve stimulation in patients using a new surgical approach for sacral neuromodulator implantation. Modification of the implantation method with sacral laminectomy and bilateral electrode placement led to distinct improvement of stimulation, positioning and dislocation. We developed tailored laminectomy for bilateral neuromodulator electrode implantation to minimize surgical trauma. Tailored laminectomy was performed in 6 patients with urge incontinence and 3 with a hypocontractile detrusor. After making a 10 cm. longitudinal skin incision we exposed the spinous processes of S2 and S3. Instead of complete 2-level laminectomy, only 2 oval laminectomy holes were made with a high speed ball drill. An electrode fixation hole was drilled at the edge of the laminectomy window and the wire was fixed with nonabsorbable suture material. In patients with idiopathic urge incontinence (followup 12.5 months, range 7 to 18) the number of leaks decreased from 7.2 to 0 daily and functional bladder capacity increased from 298 to 352 ml. In patients with a hypocontractile detrusor (followup 10.5 months, range 6 to 20) detrusor pressure increased during voiding from 12 to 34 cm. water and post-void residual decreased from 350 to 58 ml. Average surgery time was 2 hours 15 minutes. In 1 case a seroma developed near the impulse generator. Tailored laminectomy is a fast, minimally invasive and reliable technique for neuromodulator implantation.

Brachiocephalic jump graft fistula: an alternative for dialysis use of elbow crease veins.

Elbow crease fistula can be an alternative for autologous vascular access. Either brachiocephalic or brachiobasilic fistulas could be chosen according to the venous anatomy at the elbow crease. When a median antecubital vein is not present, the cephalic vein is usually too far away from the brachial artery. Thus, a end-to-side fistula must usually be performed after an extensive dissection of the distal part of the vein. In this way, only the proximal cephalic vein can be used for dialysis. To overcome this drawback, a brachiocephalic jump graft fistula was designed. A short segment of polytetrafluoroethylene graft, 6 mm in diameter, is tunneled under the skin and anastomosed to the artery and vein through two short longitudinal skin incisions. From 1981 to 1995, 222 brachiocephalic graft jump fistulas were constructed. The mean age of the patients was 56.1 years, 20% had diabetic nephropathy, and 61.7% had a previously failed angioaccess. Follow-up was obtained in 92.4% of the patients, and overall follow-up was 6,665 fistula-months. Early failure was observed in 4% of the cases. The complication rate was two episodes per 100 fistula-months of follow-up. Primary patency rates (event-free patency) were 85%, 67%, 48%, and 34% at 1, 3, 5, and 7 years. Secondary patency rates (overall patency) were 85%, 72%, 56%, and 43% at 1,3, 5, and 7 years. There were no differences between primary and secondary curves. Brachiocephalic graft jump fistula is a reliable technical variation of elbow crease fistulas for dialysis and can be another alternative to graft access when the cephalic vein is dominant at the elbow crease.

Release of ulnar nerve compression at the elbow through a transverse incision

The purpose of this study was to modify the classical longitudinal skin incision to avoid injury to the cutaneous nerve branches on the medial side of the elbow when a surgical release of the ulnar nerve was performed. Injury to the medial antebrachial cutaneous nerve is not a rare complication after release of the ulnar nerve at the elbow. This will leave an area of hyposthesia on the posteromedial aspect of the proximal forearm, to which the patient will usually get accustomed. Some patients may have an area of skin dysesthesia and a painful amputation neuroma requiring surgical treatment. To avoid these complications and yet to obtain adequate exposure for ulnar nerve release, we have used a transverse incision in 20 patients without any sequelae of hyposthesia or amputation neuromas and have attained a far superior esthetic result.

A CASE OF ARTERIOVENOUS FISTULA OF THE LOWER EXTREMITY CAUSED BY BLUNT TRAUMA

We report a intersting case of arteriovenous fisula of the lower extremity caused by blunt trauma. A 34-year-old man presented to a hospital because of a left lower leg tumor. At age 32, he had sustained a bruise on his lower leg with a soft ball while playing baseball. He had noticed an elastic, hard, large tumor about 8×7cm in the medial porfrom of the lower leg on the left. The tumor showed no pulsation but we detected blood flow in the tumor with color Doppler imaging. Angiography revealed a microfistula type of arteriovenous fistula suppled by feeding arteries from muscle branches of the posterior tibial and peroneal arteries. CT scan of the lower leg revealed a remarkably dilated vessel including an arteriovenous communication. Under an Esmarch bandage, a 15cm longitudinal skin incision was made inthe sural region. The arteriovenous fistula was easily removed. The patient has has an uneventful course for one year and eight months, to date. We describe this interesting case of arteriovenous fistula of the lower extremity caused by trauma.

Helium-neon laser irradiation at fluences of 1, 2, and 4 J/cm2 failed to accelerate wound healing as assessed by both wound contracture rate and tensile strength.

Reports in the literature indicate that low energy laser irradiation has a biostimulatory effect on wound healing; however, no mechanism of this effect has been elucidated. We attempted to establish a model from which to study the mechanism of biostimulation. The effects of low energy helium-neon irradiation on wound healing were observed in two rat models. In the first model, 1.5 cm diameter full thickness excisional skin defects were created in the dorsal midline of rats (n = 32). All animals were anesthetized and all eschars were debrided daily. Wound area was determined by caliper measurements for 2 weeks postoperatively. Rats that received a treatment of 1 J/cm2 had two defects in the dorsal skin. One wound was treated and the second was used as its own control. These measurements were not blinded. Rats that received 2 J/cm2, 4 J/cm2, or anesthesia alone had one defect on the dorsal skin. Caliper measurements of these wounds were blinded. We were unable to demonstrate any difference in the rate of wound contracture in rats that received a daily dose of 1 J/cm2, 2 J/cm2, 4 J/cm2, or anesthesia alone (P > 0.8 by student's t-test). In the second model, a single 2 cm longitudinal full thickness skin incision was created in the dorsal midline of each rat (n = 24). No difference was found between rats that received anesthesia alone and those treated daily with 2 J/cm2 as assessed by tensile strength measurements on postoperative days 7 and 14 (P > 0.8 by student's t-test between groups at both time points). These determinations were blinded. Despite our intentions of studying the mechanism of low energy HeNe biostimulation, we were unable to demonstrate a beneficial effect. In this study, helium-neon laser irradiation produced no measurable benefit on wound healing.

Helium‐neon laser irradiation at fluences of 1, 2, and 4 J/cm2 failed to accelerate wound healing as assessed by both wound contracture rate and tensile strength

Background and Objective Reports in the literature indicate that low energy laser irradiation has a biostimulatory effect on wound healing; however, no mechanism of this effect has been elucidated. Study Design/Materials and Methods: We attempted to establish a model from which to study the mechanism of biostimulation. The effects of low energy helium-neon irradiation on wound healing were observed in two rat models. In the first model, 1.5 cm diameter full thickness excisional skin defects were created in the dorsal midline of rats (n = 32). All animals were anesthetized and all eschars were debrided daily. Wound area was determined by caliper measurements for 2 weeks postoperatively. Rats that received a treatment of 1 J/cm2 had two defects in the dorsal skin. One wound was treated and the second was used as its own control. These measurements were not blinded. Rats that received 2 J/cm2, 4 J/cm2, or anesthesia alone had one defect on the dorsal skin. Caliper measurements of these wounds were blinded. We were unable to demonstrate any difference in the rate of wound contracture in rats that received a daily dose of 1 J/cm2, 2 J/cm2, 4 J/cm2, or anesthesia alone (P > 0.8 by student's t-test). In the second model, a single 2 cm longitudinal full thickness skin incision was created in the dorsal midline of each rat (n = 24). No difference was found between rats that received anesthesia alone and those treated daily with 2 J/cm2 as assessed by tensile strength measurements on postoperative days 7 and 14 (P > 0.8 by student's t-test between groups at both time points). These determinations were blinded. Results Despite our intentions of studying the mechanism of low energy HeNe biostimulation, we were unable to demonstrate a beneficial effect. Conclusion In this study, helium-neon laser irradiation produced no measurable benefit on wound healing. Lasers Surg. Medicine 20:340–345, 1997. © 1997 Wiley-Liss, Inc.

S-73-2 - N-acetyl aspartyl glutamate (NAAG) and N-acetylated alpha linked acidic dipeptidase (NAALADase): Their roles in normal and pathologic glutamatergic functions

N-Acetylated-α-linked acidic dipeptidase (NAALADase) hydrolyzes N-acetyl-aspartyl-glutamate (NAAG) to liberate N-acetyl-aspartate and glutamate. NAAG is a putative neurotransmitter and acts as a mixed agonist/antagonist on N-methyl-d-aspartate (NMDA) receptors and acts as an agonist on the metabotropic glutamate receptor 3 (mGluR3). In the present study, we examined the role of spinal NAALADase in the maintenance of mechanical allodynia induced by carrageenan injection, skin incision and mild thermal injury using 2-(phosphonomethyl)pentanedioic acid (2-PMPA), a specific NAALADase inhibitor, in rats. Mechanical allodynia was induced by injection of 2 mg carrageenan into the paw (carrageenan model), by creating a 1-cm longitudinal skin incision of the plantar aspect of the foot (post-operative model), or by application of thermal stimulation (52.5°C) for 45 s to the hind paw (mild thermal injury model). 2-PMPA was administered intrathecally at the time when the maximum mechanical allodynia occurred. Mechanical allodynia was assessed by the measurement of mechanical threshold using von Frey filaments. The mechanical threshold was measured 5, 15, 30, 60 and 90 min after the drug administration. In the carrageenan model, 100 μg of 2-PMPA attenuated the level of mechanical allodynia. 2-PMPA had no effect on the level of mechanical allodynia in both the post-operative pain model and the mild thermal injury model. These data suggested that the inhibition of spinal NAALADase alleviated mechanical allodynia induced by paw carrageenan injection.

The influence of intestinal flora on wound healing in mice.

The wound healing process was analyzed using male ICR germ-free (Gf) mice and their conventionalized (Cvz) counterparts to determine whether intestinal flora has any influence on the wound healing of a host. A longitudinal skin incision of about 35 mm was made in the dorsum of each mouse, and six interrupted sutures with 5-0 monofilament nylon thread laid for wound closure. Mice from both groups were killed on the 3rd, 7th, and 14th postoperative days, and the tensile strength of the healing wound and hydroxyproline (HP) concentration in the biologically active zone were measured as parameters of wound healing. The daily nitrogen balance and urinary creatinine excretion were also measured for 8 days. The Cvz mice showed greater tensile strength of the wound on the 3rd and 7th postoperative days, and a higher ratio of HP concentration, being wound tissue/control tissue, than their counterparts. The Cvz mice also thrived more prominently than the Gf mice, showing a positive nitrogen balance with limited urinary creatinine excretion. These results suggest the enhancing effect of normal intestinal flora on wound healing, probably through the beneficial nutritional effects supplied by the bacteria.

Transposed basilic vein-brachial arteriovenous fistula: an alternative vascular access for hemodialysis.

Twenty-five brachial-basilic arteriovenous (AV) fistulas with transposed basilic vein for alternative vascular access were created in 22 chronic hemodialysis patients. This surgical procedure was performed under brachial block or general anesthesia. After a longitudinal skin incision that was made in the inner side of the arm, the basilic vein was exposed, transposed subcutaneously, and anastomosed end-to-side to the brachial artery. The follow-up was between 7 and 24 months. Early complications were hemorrhage, thrombosis, steal syndrome, and swelling of the arm. Among the late complications were failure of the fistula because of thrombosis and multiple stenosis at the site of venipuncture. The accumulated one-year patency rate of fistulas was 81%. The complications of high-output cardiac failure or local infection were not seen in our study. On the basis of our results, the brachial-basilic AV fistula with transposed basilic vein is a useful and safe second- or third-choice vascular procedure for hemodialysis patients, in particular for women without good quality of vessels.

当科におけるＲＡ肘に対する滑膜切除術の治療成績

Of patients with RA of the elbow treated by synovectomy in our department, 10 (12 elbows) in whom postoperative follow-up observations were feasible, were evaluated for the results of the operative treatment. They consisted of 3 males (5 joints) and 7 females (7 joints) with a mean age of 63.2 years and a mean follow-up period of 4 years. The affected synovium was removed through a longitudinal skin incision laterally. During the follow-up period, we noted relief of pain, improvement of the ranges of elbow flexion and extension, forearm supination and pronation in almost all the patients. An improvement of ADL was also prominent with the restoration of the patients' abilities to comb their hair with their hands, to eat and to hold Something. The results of the operation were thus quite gratifying with a definite improvement achieved in the range of motion of the joint and also of ADL.

Results of deep dorsal vein ligation for venogenic impotence

We treated seventy venogenic impotence with ligation of the deep dorsal vein of the penis. Their corporal veno-occlusive function was evaluated by dynamic infusion cavernosometry and cavernosography (DICC). Under local anesthesia, we made a longitudinal skin incision at the base of the penis. The deep dorsal vein was ligated and also a portion of this vein of 1.5 cm long was resected together with branches surrounding the vein. After the operation, the infusion rate determined by DICC was confirmed to be decreased in almost all patients. Thirty nine out of seventy cases had their erectile capability restored and reported that they could achieve sexual intercourse. Sixty one of the seventy cases showed full erection together with an intracavernous papaverine injection. However fifty percent of the sixty one patients who became capable of obtaining erection with the treatment had lost their erectile capability again within one year of the operation, however the other fifty percent were shown to maintain their erectile capability for up to three years. As four years after the treatment only thirty percent of those who had achieved the initial erectile capability still remained potent. This operation is easy to perform without any major complications, and its outcome is as good as that achieved by other more invasive venous ligation in the treatment of patients with venogenic impotence. We therefore conclude that penile deep dorsal vein ligation and partial resection of the vein one of the most useful treatments currently available for venogenic impotence and should be the treatment of choice.