Subcutaneous Fluid Collection Research Articles

Galea-cranium suture method for prevention of the subcutaneous fluid collection--technical note.

A simple method is described for preventing cerebrospinal fluid (CSF) from collecting in the subcutaneous space following a supratentorial osteoplastic craniotomy. A few pairs of oblique holes through which suture materials may pass are made by drilling in the surface cortex of the bone flap. The galea aponeurotica is sutured to the bone flap by means of these holes. These galea-cranium sutures reduce the subgaleal free space in which pooling of CSF or hematoma may occur.

Repair of congenital sternal cleft in infants and adolescents

Background. Clinical and surgical aspects of sternal cleft repair are presented. Primary repair in the neonatal period is the best management for this rare condition, but none of the patients in this report were referred to us during that period. Autologous repair is suitable for older patients because it avoids problems related to the implant of prosthetic materials. Methods. This article reviews 8 cases of sternal cleft not associated with ectopia cordis in patients presenting between October 1979 and November 1997. Surgical repair consisted of three sliding chondrotomies, three posterior sternal wall repairs, one combination with the Ravitch technique for pectus excavatum repair, and one posterior sternal wall repair associated with total repair of Cantrell’s pentalogy. Results. All patients who submitted to surgical correction had good aesthetic and structural results. The postoperative period was uneventful except that a subcutaneous fluid collection developed in 1 patient. The mean hospital stay was 5.8 days. The patients were followed up from 4 months to 18 years. Conclusions. Whether dealing with older children or young adults, the technique of reconstructing a new sternum with a posterior periosteal flap from sternal bars and chondral grafts is a simple, quick, inexpensive, and effective option.

Traumatic Lumbar Pseudomeningocele Occurring with Spina Bifida Occulta

Pseudomeningocele in the lumbar spine due to spinal fractures or surgical procedures are well-recognized complications. We treated a 24-year-old man who fell from a horse, landing on his buttocks, and developed headaches, back pain, and a large lumbar subcutaneous fluid collection. Plain radiographs and magnetic resonance (MR) imaging revealed a midline defect in the sacral lamina and a large fluid collection in the subcutaneous space consistent with cerebrospinal fluid (CSF). He was treated conservatively, his symptoms resolved, and follow-up MR imaging showed resolution of the CSF accumulation. To our knowledge, there have been no cases of traumatic pseudomeningocele related to spina bifida occulta reported in the literature. The authors postulate that congenital defects in the neural arch contribute to the occurrence of this entity, and nonsurgical treatment should be the initial course.

A Simple Strategy for Treating Persistent Subcutaneous Cerebrospinal Fluid (CSF) Collections Following Complex Neurosurgical Procedures

Subcutaneous CSF (CSF "pseudocyst") may occur following complex skull base operations. They may respond to a trial of compressive bandages and continuous lumbar drainage that can resolve over months. When this management strategy fails, reoperation is an option, which however would require complex reconstructive procedures at the base of the skull, and still have the chance of not resolving the problem.We describe here a simple alternative treatment, consisting of a "pseudocyst"-peritoneal shunting using a flow-regulated unishunt system. This management strategy has been used successfully in two cases showing subcutaneous CSF collections following complex skull base surgery procedures which did not respond to a trial of conservative management. A prompt resolution of such a complication was achieved in all cases, which persisted during the follow-up (7 to 19 months, averaging 12 months). "Pseudocyst"-peritoneal shunting using a flow-regulated valve can be a very simple though effective management option for persistent CSF subcutaneous collections following major neuro-surgical procedures.

Direct and indirect revascularization for Moyamoya disease surgical techniques and peri-operative complications

We have performed surgical treatment for Moyamoya disease using the superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-arterio-myo-synangiosis (EDAMS). In this paper, the surgical technique of combined revascularization for Moyamoya disease as well as peri-operative complications are discussed. Craniotomy and dural opening were extensively carried out to expose the brain surface as widely as possible. Dissection of the STA, which is the most powerful resource of direct revascularization, should be carefully carried out using a surgical microscope. The temporal muscle and middle meningeal artery, which have the most potential as sources of indirect revascularization, must be preserved. STA-MCA anastomosis to the frontal branch of the middle cerebral artery is indispensable for improving cerebral circulation of the frontal lobe. A small arachnoid membrane opening and water-tight closure are also important to avoid post-operative subdural and subcutaneous fluid collection. Ischemic events disappeared immediately after surgery in most cases. However, in several cases, transient ischemic attacks recurred for several months after the surgery. Chronic subdural hematoma was seen in two cases.

Proximal migration and subcutaneous coiling of a peritoneal catheter: report of two cases

The authors report two cases with a rare complication of ventriculoperitoneal shunt. The peritoneal catheters migrated upward to the scalp and to the clavicular area. In one case, the whole length of the peritoneal catheter was pulled out from the peritoneal cavity and was coiled subcutaneously. Both of the patients had the habit of head rotation and one of the patients had a history of subcutaneous fluid collection at the site of coiling. At surgery, whitish inflammatory granulation tissues were noted around the catheter in both cases, which might act as an anchoring point for the "windlass effect".

Milk of calcium fluid collection in dermatomyositis: Ultrasound findings

Extensive subcutaneous and intermuscular calcium laden fluid collections (milk of calcium) were found in two young girls with severe dermatomyositis. Sonographic examination clearly showed the nature and extent of the collections. Knowledge of this new feature of dermatomyositis should help avoid confusing these fluid collections with soft tissue infection and deep abscess in these often steroid dependent children.

Complications Associated with Thoracocentesis

In order to determine the spectrum and frequency of complications associated with thoracocentesis, we decided to audit prospectively all thoracocentesis performed in the medical service at our institution. Over a ten-month interval, 125 procedures were performed. We identified 114 (91 percent) prospectively, 11 retrospectively by a computer-assisted review of discharge summaries. Forty-six percent of the procedures were complicated by at least one adverse occurrence. Complications considered major occurred in 14 percent, minor in 33 percent. The major complications included 14 pneumothoraces (three required tube thoracostomies and one percutaneous aspiration), one splenic laceration, one sheared-off catheter, and one pneumohemothorax. The minor complications included pain in 28, persistent cough in 14, dry taps in 16, and subcutaneous fluid collections in four patients. We conclude that thoracocentesis can carry the risk of frequent morbidity even when a lecture and printed guidelines on performing thoracocentesis have been given and experienced individuals are in attendance during the performance of the procedure. Our study suggests a portion of this morbidity may be from poor technique, inability to adequately identify landmarks, and improper utilization of a needle-catheter apparatus. Suggestions for correction of these problems are made.

NEW YORK ACADEMY OF MEDICINE, SECTION OF NEUROLOGY AND PSYCHIATRY, AND NEW YORK NEUROLOGICAL SOCIETY

Observation of painful scalp areas during migraine headache has shown that lowered deep-pain threshold, local edema, and alteration of tissue turgor were nearly constant findings. Hematomata and painful subcutaneous fluid collections were by no means rare. Furthermore, microscopic examination of the bulbar conjunctiva during headache revealed marked dilatation of all vascular structures with occasional venular hemorrhages. When the vasoconstrictor agents arterenol or ergotamine tartrate were administered, these evidences of local tissue alteration (i. e., edema and lowered deep-pain thresholds) were eliminated more rapidly than occurred spontaneously. Edema of the bulbar conjunctiva has been terminated during arternol infusion at a rate sufficient to attenuate and increase spasticity of the local arterioles. Dilated conjunctival vessels in headache have been shown to be more resistant to the constricting properties of topical arterenol than the vessels on the headache-free side. Local instillation of cortisone suspensions increased the sensitivity to arterenol. These observations confirmed the postulate that there was a substance or substances locally present in scalp areas involved with headache, whose release occurred during vasodilatation and whose withdrawal from the tissue was promoted by vasoconstriction.

NEW YORK ACADEMY OF MEDICINE, SECTION OF NEUROLOGY AND PSYCHIATRY, AND NEW YORK NEUROLOGICAL SOCIETY

Observation of painful scalp areas during migraine headache has shown that lowered deep-pain threshold, local edema, and alteration of tissue turgor were nearly constant findings. Hematomata and painful subcutaneous fluid collections were by no means rare. Furthermore, microscopic examination of the bulbar conjunctiva during headache revealed marked dilatation of all vascular structures with occasional venular hemorrhages. When the vasoconstrictor agents arterenol or ergotamine tartrate were administered, these evidences of local tissue alteration (i. e., edema and lowered deep-pain thresholds) were eliminated more rapidly than occurred spontaneously. Edema of the bulbar conjunctiva has been terminated during arternol infusion at a rate sufficient to attenuate and increase spasticity of the local arterioles. Dilated conjunctival vessels in headache have been shown to be more resistant to the constricting properties of topical arterenol than the vessels on the headache-free side. Local instillation of cortisone suspensions increased the sensitivity to arterenol. These observations confirmed the postulate that there was a substance or substances locally present in scalp areas involved with headache, whose release occurred during vasodilatation and whose withdrawal from the tissue was promoted by vasoconstriction.