Postoperative Compression Research Articles

Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures

To evaluate the efficacy of unipedicular kyphoplasty in the treatment of patients with osteoporotic vertebral compression fractures, we compared the pre- and postoperative clinical and radiological results in the unipedicular and bipedicular kyphoplasty groups. The clinical and radiological results of unipedicular kyphoplasty were as good as those of bipedicular kyphoplasty. The purpose of this study was to evaluate the efficacy of unipedicular kyphoplasty in the treatment of patients with osteoporotic vertebral compression fractures. We compared the pre- and postoperative compression ratios (CRs), kyphotic angles (KAs), and visual analogue scale (VAS) scores of the patients in the unipedicular and bipedicular kyphoplasty groups. The results showed that the clinical and radiological results of unipedicular kyphoplasty were as good as those of bipedicular kyphoplasty. Percutaneous balloon kyphoplasty is a therapeutic option for patients with painful osteoporotic vertebral compression fractures (VCFs). Due to the relatively high-risk nature of the patient population, complications such as myocardial events, seizures, agitation, or dyspnea may occur and render completion of the procedure imprudent. We analyzed the clinical and radiological results of unipedicular and bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures. We retrospectively reviewed the records of 45 patients who underwent balloon kyphoplasty for the treatment of VCFs between January 2005 and April 2008. A unipedicular approach was used in 15 patients and a bipedicular approach was used in 30 patients. The CR, KA, and 100-point VAS score for pain were measured pre- and postoperatively in each patient. There was no significant difference in restoration of the CR (p = 0.376) and KA (p = 0.888) between the unipedicular and bipedicular kyphoplasty groups. The patients in the unipedicular group showed greater improvement in VAS score than those in the bipedicular group (p < 0.001). There were no postoperative complications, such as nerve injury or pedicle fracture, in either of the two groups. The clinical and radiological results of unipedicular balloon kyphoplasty for the treatment of VCFs were as good as those of bipedicular balloon kyphoplasty. Thus, unipedicular balloon kyphoplasty can be used as an alternative treatment for patients with VCFs.

Eccentric Mastectomy and Zigzag Periareolar Incision for Gynecomastia

Gynecomastia is enlargement of the male breast caused by gland proliferation. Surgery is performed for symptom relief or for cosmetic reasons. The authors used a modified operative procedure, then evaluated the results and safety. Between 2001 and 2005, 22 men (median age, 26 years; range, 13-63 years) with gynecomastia underwent surgery. The operative procedure included a zigzag periareolar skin incision, eccentric subcutaneous mastectomy, and liposuction, with postoperative compression. All the patients were satisfied with the results of the surgery, which produced a chest contour resembling a normal male chest rather than simply a smaller breast. The only complication was a hematoma. One patient was found to have breast cancer. The normal male chest contour can be restored by the described method of eccentric subcutaneous mastectomy.

Suture Repair of Pectus Excavatum at the Time of Cardiac Surgery on an Infant

An 11-month-old girl was diagnosed with pulmonary atresia with intact ventricular septum and symmetrical pectus excavatum that had developed after prior palliative operation. We performed a transannular patch repair and atrial septal defect closure. Simultaneously, to prevent postoperative right ventricular outflow tract compression, the sternum was elevated by two 1-0 braided polyester horizontal mattress sutures on the posterior side of the third and fourth costal cartilages. Postoperative respiratory distress did not occur and her hemodynamics was stable. Four months later, she is alive and well without recurrence of the thoracic deformity.

The Influence of Endplate-to-Endplate Cement Augmentation on Vertebral Strength and Stiffness in Vertebroplasty

Controlled in vitro trial. To study vertebral strength in relation to cement augmentation technique after vertebroplasty and to assess the influence of the biomechanical compression model on postoperative results. In the treatment of osteoporotic vertebral fractures, the role of vertebroplasty has been well established. Biomechanical compression models thus far used, compressing vertebrae by only 25% of their initial height, did not show a correlation between cement augmentation volumes and postoperative compression strength. In these studies, even very small volumes of cement seem effective. However, these models may not realistically simulate clinically relevant osteoporotic wedge fractures. We hypothesize that, in clinically relevant osteoporotic wedge fractures, postoperative vertebral body strength is strongly dependent on endplate-to-endplate cement augmentation. Twenty-five intact osteoporotic cadaver vertebrae were obtained (10 lumbar, 15 thoracic). In 21 vertebrae, anterior wedge fractures (AO type A1.2) were created by controlled external force, with preset height reduction by 35%. After height reconstruction, 9 vertebrae were augmented endplate-to-endplate and 12 vertebrae were partially augmented with polymethylmethacrylate (PMMA). Another 4 vertebrae were compressed by only 25%. Posttreatment strength and stiffness of the vertebrae were determined by a compression test identical to the pretreatment compression protocol. In the 35% compression group, posttreatment strength was significantly decreased in vertebrae that were partially augmented with cement compared with the endplate-to-endplate augmented group (767 +/- 257 N vs. 1141 +/- 325 N, P < 0.01). Postoperative strength amounted 106% +/- 27% of preoperative strength values in the endplate-to-endplate augmented vertebrae, compared with 65% +/- 18% in the partially augmented vertebrae (P < 0.001). In the 25% compression group, results in height restored and augmented vertebrae were similar to the nontreated vertebrae. Endplate-to-endplate PMMA augmentation restores the biomechanical properties of vertebrae in clinically relevant anterior wedge fractures. Our preliminary data suggest that biomechanical models with only 25% compressive deformation unlikely form a good model to assess the mechanical effects of cement augmentation in osteoporotic fractures.

Compression Garments 101

To review the importance of postoperative compression and compression garments to promote postoperative healing and improved aesthetic results. --Understand the importance of proper postoperative compression and the selection of the proper compression garment. --Identify the important elements to look for in a compression garment. --Define the necessity of educating staff for proper garment selection. --Explain how to correctly measure to determine the proper garment(s) and garment sizing.

Randomized clinical trial comparing bipolar coagulating and standard great saphenous stripping for symptomatic varicose veins

Typical side-effects of saphenous stripping for symptomatic varicose veins include painful thigh haematomas, which a new bipolar coagulating electric vein stripper (EVS) may reduce. In a randomized, single-blind trial at three vascular centres, 99 patients were assigned to EVS and 101 to conventional stripping. The primary outcome was postoperative pain at rest and following physical exercise (climbing stairs). Haematomas were quantified by ultrasonography. Further endpoints were duration of postoperative compression, sick leave and quality of life (measured by the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ) and Short Form 36 (SF-36). Mean resting visual analogue scale for pain 24 h after surgery was 1.6 in the EVS group and 3.3 in the conventional stripping group (mean difference 1.7, 95 per cent confidence interval (c.i.) 1.4 to 1.9, P < 0.001). Mean ratings following exercise were 3.3 and 5.5 (mean difference 2.3, 95 per cent c.i. 2.0 to 2.6, P < 0.001) respectively. No patient in the EVS group had a measurable thigh haematoma, compared with 74 patients after conventional stripping (P < 0.001). The EVS significantly decreased the length of compression therapy and sick leave, and produced superior CIVIQ and SF-36 ratings. The EVS was safe and effective in avoiding painful haematomas following varicose vein surgery.

Elastic compression for varicose vein surgery

SummaryIn daily clinical practice the elastic compression before and after varicose vein surgery is not standardized and there are no clear indications on techniques or materials to use, especially for uncomplicated varicose disease (i.e., absence of ulcers, lymphoedema). Aim of the study was to evaluate the current use of elastic compression for varicose vein in different vein surgical settings in Italy, and to compare Italian practice to the customary approaches used in other European countries. Methods: A national survey exploring pre-, intra and postoperative practice in varicose vein surgery was conducted among surgical departments throughout Italy. Results: The survey, involving practice patterns in 112 Italian venous Surgical departments (26,792 venous operations), showed that a large number of survey respondents ( 57/112), considered use of elastic compression as „non indispensable” in the preparation for varicose vein surgery, but all of them applied compression in the immediate post operative management and at discharge. However, techniques and materials employed for postoperative elastic compression were generally based on personal opinions and thereby, were largely dissimilar among centres. Conclusion: The use of elastic compression for varicose vein surgery is still applied with disparate modalities according with the individual’s experience. Efforts toward more uniformed and wide application of elastic compression need to be implemented. Standardization in the management for varicose venous surgery will reflect in better results also in terms of cost-effectiveness and patient care.

Die Lastübertragung verschiedener Schenkelhalsendoprothesen auf das Femur

Aiming to reduce known complications of stemmed implants, such as resorptive bone remodeling or bone damage in revision, implants with only epi-metaphyseal anchorage have been developed. In the following study the influence of three different femoral neck endoprostheses, CUT, CIGAR (ESKA Implants Lübeck) and TPP (SulzerMedica) on the postoperative load transfer to the femur was investigated in comparison to a cementless hip stem. Using a composite femur model and photoelastic coating technique, the pre- and postoperative osseous strain was measured under static loading. The load corresponded to the absolute maximum of the hip joint load during walking. Statistical analysis was based on the interval of 99 % confidence which was generated by the preoperative measurements. The different anchorage concepts of the femoral neck endoprostheses exhibited a significant influence on the load transfer, especially along the medial and lateral cortical bone. But, in comparison, the cementless hip stem caused more pronounced stress-shielding which can induce resorptive bone remodelling. One specific femoral neck anchorage concept led to a change from preoperative tension to postoperative compression at the lateral cortical bone. This regionally limited effect may influence in the mid- or long-term the local bone remodeling in a negative manner.

Preservation of C7 spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy

Axial pain is one of the major complications after laminoplasty, and preservation of C7 spinous process during the procedure can reduce the axial pain. However, it has not been elucidated whether laminoplasty preserving the C7 spinous process can maintain neurological improvement for a long time. The purpose of our retrospective study was to investigate the long-term neurological outcome after open-door laminoplasty preserving the C7 spinous process for cervical spondylotic myelopathy (CSM). Clinical and radiological outcomes were analysed in 42 patients who underwent open-door laminoplasty preserving C7 spinous process and followed up for more than 5 years. Neurological function was evaluated by means of the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. Axial pain was assessed using a visual analog scale (VAS) at the last examination. Alignment and motion of the cervical spine were measured from radiographs, and magnetic resonance imaging (MRI) was used to evaluate postoperative compression at C7. The mean JOA score was 9.4 before surgery and 12.0 at the latest follow-up. The mean VAS score in 26 patients score was 9.7/100. No compression of the spinal cord was observed in any MRI at the latest follow-up. Preservation of the C7 spinous process does not influence the long-term outcome of CSM after laminoplasty. Although we did not have a comparative group, the procedure described here should be considered as the solution.

Endovascular therapy for chronic, central type, deep vein thrombosis

Our aim was to explore the feasibility and effectiveness of endovascular therapy for chronic, central type, deep vein thrombosis (DVT). A total of 46 iliac vein thrombotic patients with a history of 3 months to 12 years received endovascular therapy. There were 38 cases involving the left lower limb and eight the right lower limb. The average circumference of the affected lower extremities, which was taken 10 cm above the knee before surgery, was 8.9±6.4 cm longer than the corresponding unaffected limb. One to three self-expanding stents with a diameter of 12 or 14 mm were deployed in each thrombotic iliac vein through incision of the femoral vein under supervision of digital subtraction angiography with general or epidural anaesthesia. Strict anticoagulation with an internationalized normalised ratio between 2–3 and an elastic support with elastic stockings were then used life long. Three cases failed because of the inability to pass through a wire or catheter. Forty-three cases were successful (93.5%). An average of 2.2 stents were deployed in each occluded iliac vein. Complete venography demonstrated immediate reactivation of the occluded iliac veins with an obvious decrease in compensational collateral venous branches. The average difference in the circumference of the thigh dropped to 2.6±1.7 cm within 3 days postoperatively. A follow-up of 2–36 months showed eight patients suffering from re-occlusion because of a pause or interruption in the anticoagulation therapy. The remaining 35 cases remained patent. Endovascular therapy is a choice for chronic, central type DVT, and postoperative anticoagulation and compression therapy are of great importance for patency. The mid- and long-term results must still be determined.

Safety of Upper Extremity Surgery After Prior Treatment for Ipsilateral Breast Cancer: Results of an American Society for Surgery of the Hand Membership Survey and Literature Review

Lymphedema, infection, and healing delay are among feared complications in patients undergoing upper extremity surgery after prior mastectomy and axillary dissection with or without radiation therapy. Most of these cancer patients are advised to avoid any procedure on their ipsilateral upper extremity including blood pressure monitoring, intravenous punctures, and surgery. As a result, many of these patients hesitate to undergo necessary upper extremity surgery such as arthritis surgery and even carpal tunnel release. Many hand and upper extremity surgeons believe that these precautions are unnecessarily stringent and believe that indicated upper extremity surgeries could be performed safely in these patients. We surveyed 1,200 members of The American Society for Surgery of the Hand and the 606 returned questionnaires were analyzed. More than 95% of the hand surgeons surveyed do not hesitate to perform surgery on an upper extremity in a patient after ipsilateral lymphadenectomy and/or irradiation, decreasing to 85% if there is pre-existing chronic lymphedema; 94% use a tourniquet in a routine fashion (74% use a tourniquet in the presence of existing lymphedema); 46% use a Bier block when clinically indicated (only 21% would use a Bier block in a patient with lymphedema); and 36% are comfortable using an axillary block (25% in the case of lymphedema). Thus, most of the polled surgeons would prefer to perform surgery on these patients under a general anesthetic, but still would use an extremity tourniquet for a bloodless surgical field in their routine manner. The rate of reported complications in these patients was 23% in patients with pre-existing chronic lymphedema and only 3% in patients with no lymphedema. After surgery, 46.2% of the surgeons do not undertake any additional precautions than in their routine practice with all upper extremity surgery patients. However, 53.8% would change their routine practice for such patients and these changes range from placing the surgical tourniquet on the forearm instead of the upper arm, use of perioperative prophylactic antibiotics in all patients irrespective of the type of surgery, use of postoperative compression garments, and specific postoperative hand therapy aimed at the prevention of postoperative edema.

Preliminary Results Using a Magnet-Embedded Compression Garment after Liposuction Surgery

Introduction: Magnetic fields have been touted as a cure and method of treatment for a variety of illnesses and medical conditions, and revenues from the sales of health-related magnetic products reportedly add up to billions of dollars. Magnets and the magnetic fields they create are marketed as having no associated risks; however, the medical community questions their benefits, and the Food and Drug Administration has not approved static magnetic fields for the treatment of any medical ailment. Methods and Materials: This study evaluated the postoperative effects of a magnetic garment on patients undergoing liposuction. For each standard postoperative compression garment, one half was fitted with elasticized magnetic neoprene material and the other half with nonmagnetized neoprene. The manufacturer sent the garments to the authors without identifying which sides had the active magnetic strips. Results: Preliminary results of this study showed no statistical difference in bruising, swelling, or postoperative results between the magnetized and the nonmagnetized treated areas. Although theories abound concerning the effects of magnetic field on optimizing the supply of nutrients and oxygen to the magnetic field area, this clinical study did not support any significant difference in the rate of wound healing. However, this study did show that pain and tenderness were markedly reduced on the side covered with the magnetic field. Eight of the 9 patients noted a decrease in pain and discomfort postoperatively on the left side, which was the half of the garment with the magnetized neoprene strips. The greatest reduction in pain was observed in the first 24 hours of treatment with the magnets, and the improvement increased with the passage of time. This study also found a reduction in the amount of analgesics needed by the patients using magnets during the treatment period. Discussion: Magnetic volume is important in delivering a therapeutic effect. Having more volume means that more tissues are experiencing the magnetic field. The neoprene magnetic strength is low in gauss units but high in Maxwell units because of the configuration of the north-south pole orientation described. Conversely, a unipolar magnet with a high magnetic strength delivers a low magnetic volume and is not considered important for therapeutic use. To date, researchers are uncertain whether low-level magnetic fields are hazardous to biological tissues. There has been some concern about safety issues for long-term whole-body exposure, but this may not be applicable to brief exposure to small areas of the body associated with static magnets. The theoretical basis for the physiologic response from static magnets has not been clearly identified. A search and review of the medical literature resulted in a limited number of studies. Few studies have evaluated magnets for relief of chronic pain for disease states and musculoskeletal pain, and even fewer have addressed mechanism of action.

Prevention of Deep Venous Thrombosis: The Hospital for Special Surgery Approach

Deep vein thrombosis is the most common complication after total knee and total hip arthroplasty. At the Hospital for Special Surgery we have tried to develop a multimodal approach for deep vein thrombosis prophylaxis. For patients undergoing total hip arthroplasty this approach involves multiple intraoperative and postoperative modalities. These include hypotensive epidural anesthesia, intraoperative heparin, and minimization of venous kinking during the surgery as well as postoperative pneumatic compression devices, early weight bearing, and pharmacologic prophylaxis with either aspirin or warfarin. Intraoperative measures are less important in patients undergoing total knee arthroplasty considering that the intraoperative tourniquet limits the benefits of hypotensive anesthesia and intraoperative heparin. We therefore advocate postoperative combination protocols involving pneumatic compression and either aspirin or warfarin. For institutions that do not use multimodal treatment options, low molecular weight heparin, warfarin, or modern oral thrombin inhibitors such as ximelagran (FDA approval pending) are the treatment of choice.

A phase II study of radiation with concomitant and then sequential temozolomide (TMZ) in patients (pts) with newly diagnosed supratentorial high grade malignant glioma (MG) who have undergone surgery with carmustine (BCNU) wafer insertion

1547 Background: Prior studies demonstrated the effectiveness of both BCNU wafer (Gliadel) and TMZ (Temodar) as adjunctive therapies to resection and radiation therapy (RT) in pts with initial high grade MG. (Westphal et al. Neuro-Onco 2003; Stupp et al. JCO 2002) This study assessed the safety and efficacy of BCNU wafer and TMZ in combination. Methods: This is a phase II, multicenter, trial. Eligible pts were 18–72 years (yrs) of age with surgically operable, initial high grade MG. Enrollment began in July 2003 and continues. After resection and BCNU wafer insertion, pts received concomitant treatment with daily RT 2 Gy (≤total 60 Gy) + TMZ 75 mg/m2 (≤45 days) followed by monthly TMZ (200 mg/m2 daily x 5 every 28 days, ≤18 cycles). Endpoints include survival and progression-free survival (PFS), which were estimated with the Kaplan-Meier Method: Results: As of November 2004, 16 pts have been enrolled at 2 centers. Glioblastoma multiforme was diagnosed in 15 pts. Median (range) age is 59 (29–71) yrs and median Karnofsky Performance Status is 95 (70–100). After a median follow-up of 7 (1–17) months, 7 pts have had a recurrence and 3 pts have died; 8 pts remain on active treatment and one patient withdrew consent. Median survival and PFS have not been reached. The 1-yr survival rate is 63%, and the 1-year PFS rate is 51%. Adverse events include deep vein thrombosis (3 pts), pulmonary embolism (4 pts), sterile brain abscess (1 pt) and bacterial pneumonia (1 pt). Conclusions: These data suggest combination therapy with BCNU wafers followed by RT/ TMZ may be an effective regimen in pts with initial high-grade resectable MG. Randomized trials will be needed to ultimately assess efficacy. The incidence of DVT and PE within 60 days of surgery in this pt population, despite the standard use of postoperative compression stockings and sequential compression devices, merits further evaluation. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Guilford Guilford, Schering-Plough Guilford

Pseudocyst formation after abdominal liposuction—extravasations of Morel–Lavallée on MR images

A swelling of the abdominal wall in a 27-year-old woman after undergoing liposuction is described. Pseudocyst of Morel-Lavallée was located within the abdominal fascia and removed by surgery. MRI showed a non-homogenous mass with hyper intense fluid level and septations in T2-weighted images. We speculated that MRI can be used to guide the treatment (conservative or surgical). The literature concerning liposuction is reviewed.

The use of foam as a postoperative compression dressing

Appropriate wound management is an important component in determining the outcome of surgical procedures. Increased edema can complicate postoperative results by causing wound dehiscence and increasing inflammation, and, thereby, patient discomfort. In addition, inappropriate wound management can lead to hematoma formation that increases the risk of infection and patient discomfort. These issues are likely more pertinent in high-energy trauma; however, they are also relevant in elective surgery. Results are dependent on postoperative treatment (ie, rest, ice, elevation, antiinflammatories); however, the authors believe edema control can be further facilitated by the application of a foam compression dressing.

Bloodless removal of varicose veins - a new technique

Objective: To describe the use of a novel electric vein stripper (EVS) for use in patients with varicosities of the greater saphenous vein and tributaries. Methods: In addition to standard procedures as performed in varicose veins of the lower limb, an EVS, powered by a standard high frequency electrocoagulation generator (HF), is introduced. The application of this new EVS makes it possible to avoid tearing of the structures of the subcutaneous tissue surrounding the greater saphenous vein, leaving the channel of the vein blood dry. Results: A preliminary study including two groups of patients - 20 in the Babcock group and 24 in the EVS group - resulted in significantly reduced pain and discomfort. An added benefit for the patients was the fact that postoperative compression bandages were not needed. Conclusions: Application of EVS can prevent bruising and haematomas in vein stripping can be avoided.

Résultats d’une enquête sur les techniques compressives et contensives utilisées dans le traitement chirurgical des varices

Objectives A survey on postoperative compression after varicose vein surgery was undertaken in 2001 among surgeons of the French-speaking Vascular Surgery Society as well as non-members with a heavy caseload in varicose vein surgery. The aims of the study were to 1) identify the various medical devices and protocols used postoperatively, 2) estimate the frequency and duration of use, and 3) identify the surgeon's rationale for prescribing postoperative compression. The first part of the inquiry was devoted to surgical procedures and has been previously published ( J Mal Vasc 2003; 28: 277-86). Material and methods A questionnaire with 11 items for postoperative treatments and a patient form was mailed to 675 surgeons. Results The response rate was 41.5% (280 surgeons). Results were assessed by a scientific committee. Surgeons were classified into different groups according to their membership in the French-speaking Vascular Surgery Society or not, the type of practice (private, public hospital, mixed), and caseload. Compression was widely used (97.1%). It was the only postoperative treatment for 25.2% of the surgeons, was associated with anticoagulant treatment for 38.8% or non-steroidal antiinflammatory drugs for 11.2%. Prescription was evidence-based for only 11.6%. Compression therapy was mainly started postoperatively (93.2%). Elastic bandages (long stretch) were used by 87%. Duration of bandage therapy was variable (less than 8 days for 38.8%, 8-15 days for 24.5%). After bandage therapy, medical compression stockings (above knee 74.7%) or French class II (77.9%) were used. Compression stockings were prescribed for 8-15 days or 15-30 days by 12.7% and 84.6% of the surgeons respectively. Prolonged postoperative treatment was not common (28%) and was prescribed for patients with trophic changes.

Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery.

To determine the risk of postoperative hemorrhage during a 3-year period of early postoperative administration of nadroparin (Fraxiparin) plus compression stockings in a large cohort of patients who underwent spinal surgery. A total of 1,954 spinal procedures at different levels (503 cervical, 152 thoracic and 1,299 lumbar), performed between June 1999 and 2002 at the Department of Neurosurgery, Johann-Wolfgang-Goethe University Frankfurt, were included in this study. To prevent venous thromboembolic events (VTE), all patients were routinely treated subcutaneously with 0.3 ml of early (less than 24 h) postoperative nadroparin calcium (Fraxiparin) (2850 IU anti-Xa, Sanofi Winthrop Industrie, France) plus intra- and postoperative compression stockings until discharge. The occurrence of a postoperative hematoma (defined as a hematoma requiring surgical evacuation because of space occupation and/or neurological deterioration) and a deep venous thrombosis (DVT) were recorded in a database and analyzed retrospectively. 13 (0.7%) of the 1,954 spinal operations were complicated by major postoperative hemorrhages. In 5 of the 13 patients (38.5%) the hemorrhage occurred on the day of surgery before the administration of nadroparin. Thus, the hemorrhage rate of patients receiving nadroparin was 0.4% (8/1,949). Ten (77%) of the 13 patients with major postoperative hematoma showed a progressive neurological deficit, which resolved in 6 patients and resulted in a hematoma-related morbidity of 31% (4/13). Only 1 patient (0.05%) in this series developed a clinically evident DVT, and none of the patients suffered from pulmonary embolus during the hospital stay. Although retrospective, this is to date the largest study providing information about the hemorrhage rate associated with early postoperative anticoagulation following spinal surgery. The results confirm that early postoperative pharmacological thromboembolic prophylaxis using nadroparin in patients with spinal surgery is not associated with an increased risk of postoperative hemorrhage.

Treatment of Varicose Veins: An Assessment of Intraoperative and Postoperative Compression Sclerotherapy

Since thrombotic complications, such as superficial thrombophlebitis and subsequent skin pigmentation, are common after sclerotherapy, we conducted a study to evaluate whether combining sclerotherapy with ligation of varicose veins minimizes complications and what timing for sclerotherapy would be most beneficial-accompanying surgery or several weeks postsurgery. Surgical intervention and compression sclerotherapy were performed consecutively on 111 limbs (group A), and sclerotherapy was performed 28 days after surgical intervention on 87 limbs (group B). The volume of sclerosant used and the frequency of complications (thrombus formation and pigmentation) were analyzed. Plasma levels of thrombin-antithrombin III complex (TAT) and D-dimer (DD), as markers for activation of coagulation, were compared. In group A, the total volume of sclerosant used in patients with complications was significantly higher than that in patients without complications. The frequency of thrombus formation and of pigmentation was significantly lower (p <0.01) in group B (10% and 18%, respectively) than in group A (21% and 37%, respectively). The plasma levels of TAT 7 days after treatment were significantly lower in group B (3.4 +/- 1.2 mg/L) than in group A (4.9 +/- 1.1 mg/L). Performing compression sclerotherapy 28 days after surgical intervention is effective for reducing complications and a good alternative for patients with an underlying hypercoagulable state.