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  • 1
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    Online Resource
    Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery
    Walter de Gruyter GmbH ; 2016
    In:  Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. Vol. 70, No. 6 ( 2016-12-1), p. 356-364
    Details
    In: Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., Walter de Gruyter GmbH, Vol. 70, No. 6 ( 2016-12-1), p. 356-364
    Abstract: Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005–2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.
    Type of Medium: Online Resource
    ISSN: 1407-009X
    URL: Article
    DOI: 10.1515/prolas-2016-0039
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2016
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  • 2
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    Post Operative Pain Management for Open Inguinal Hernia Repair under Ultrasound Guidance with two Different Regional Analgesia Techniques: Transversus Abdominis Plane Block VS Ilioinguinal / Iliohypogastric Nerves Block
    Walter de Gruyter GmbH ; 2014
    In:  Acta Chirurgica Latviensis Vol. 14, No. 2 ( 2014-12-1), p. 18-23
    Details
    In: Acta Chirurgica Latviensis, Walter de Gruyter GmbH, Vol. 14, No. 2 ( 2014-12-1), p. 18-23
    Abstract: Introduction. An effective postoperative analgesia is of key importance to facilitate recovery during the immediate postoperative period and to ensure early ambulation. The transversus abdominis plane block (TAP) and ilioinguinal / iliohypogastric nerves block (IHN) are a relatively new regional analgesia techniques that provide a postoperative analgesia in patients undergoing lower abdominal surgery. Aim of the Study. The objective of this study was to compare the analgesic effectiveness of ultrasound guided TAP block versus ultrasound guided IHN block in the post-operative period of unilateral open inguinal hernia repair. Materials and methods. One hundred five consented adult patients scheduled for unilateral open inguinal hernia repair were enrolled in this randomised controlled clinical study. US-guided regional analgesia with 0.5 % of levobupivacaine was performed after induction of general anaesthesia (GA). Patients were randomly allocated into two groups: Group A- 53 patients underwent TAP block vs. Group B- 52 patients underwent IHN block. All patients received a standardised GA. Both groups were comparable for age, gender, ASA, and weight. All patients were scheduled for postoperative pain assessment using a visual analogue scale (VAS) at two definite times: 1- VAS1: when patient was awake and conscious post GA; 2- VAS2: when patient requested a rescue analgesia or patient reached 17 hours post block performance. Results. There were no significant differences in age, gender, ASA, or weight between both groups (p=0.9; p=0.8; p=0.6; p=0.9 respectively). We found out significant differences comparing VAS score over the time, the IHN block had better effect than the TAP block on relieving pain at the VAS1 (p=0.03) and VAS2 (p=0.04). The duration of the blocks in group A and group B was as the following: 2-6.5 hrs= [Mean ± SD: 4.2 ± 1.5 vs. 5 ± 0.8 respectively and p=0.03]; 6.5-17 hrs= [Mean ± SD: 11.9 ± 2.3 vs. 14.4 ± 1.7 respectively and p=0.203] ; ≥ 17 hrs= [Mean ± SD: 19 ± 1.1 vs. 20.1 ± 2 respectively and p=0.003]. The results of our study were more favourable for the IHN block in all the 3 timing groups. Conclusions. Ultrasound-guided IHN block provides better pain control and longer duration of action than ultrasound-guided TAP block in the post-operative period of unilateral open inguinal hernia repair. Both regional analgesia techniques: TAP block and IHN block under ultrasound guidance for open inguinal hernia repair are simple, safe and effective pain control methods.
    Type of Medium: Online Resource
    ISSN: 1407-981X
    URL: Article
    DOI: 10.1515/chilat-2015-0004
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2014
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  • 3
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    The Detection of Beta-Herpesvirus Infection in Patients undergoing Reconstructive Flap Surgeries and Its Association with the nearest Postoperative Period Course
    Walter de Gruyter GmbH ; 2011
    In:  Acta Chirurgica Latviensis Vol. 11, No. 1 ( 2011-01-1)
    Details
    In: Acta Chirurgica Latviensis, Walter de Gruyter GmbH, Vol. 11, No. 1 ( 2011-01-1)
    Type of Medium: Online Resource
    ISSN: 1407-981X
    URL: Article
    DOI: 10.2478/v10163-012-0020-x
    Language: Unknown
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2011
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  • 4
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    Polymorphism rs2066865 in the Fibrinogen Gamma Chain (FGG) Gene Increases Plasma Fibrinogen Concentration and Is Associated with an Increased Microvascular Thrombosis Rate
    MDPI AG ; 2019
    In:  Medicina Vol. 55, No. 9 ( 2019-09-03), p. 563-
    Details
    In: Medicina, MDPI AG, Vol. 55, No. 9 ( 2019-09-03), p. 563-
    Abstract: Background and Objective: Thrombosis due to inherited hypercoagulability is an issue that has been raised in microvascular flap surgery previously. We analyzed the association of a single nucleotide polymorphism (SNP) in rs2066865 in the fibrinogen gamma chain (FGG) gene, alteration in plasma fibrinogen concentration, and presence of microvascular flap thrombosis. Materials and Methods: A total of 104 adult patients with microvascular flap surgery were subjected to an analysis of the presence of SNP rs2066865 in the FGG gene. Alterations in plasma fibrinogen concentration according to genotype were determined as a primary outcome, and flap thrombosis was defined as a secondary outcome. Results: Flap thrombosis was detected in 11.5% of patients (n = 12). Successful revision of anastomosis was performed in four patients, resulting in a microvascular flap survival rate of 92.3%. We observed an increase in plasma fibrinogen concentration in genotype G/A and A/A carriers (G/G, 3.9 (IQR 4.76-3.04); G/A, 4.28 (IQR 5.38-3.18); A/A, 6.87 (IQR 8.25-5.49) (A/A vs. G/A, p = 0.003 and A/A vs. G/G, p = 0.001). Within group differences in microvascular flap thrombosis incidence rates were observed—G/G 6/79 (7.59%); G/A 5/22 (22.7%); A/A 1/3 (33.3%) (OR 0.30 95%; CI 0.044 to 0.57), p = 0.016; RR 3.2—when G/G versus G/A and A/A were analyzed respectively. Conclusions: A/A and G/A genotype carriers of a single nucleotide polymorphism in rs2066865 in the fibrinogen gamma chain gene had a higher plasma fibrinogen concentration, and this might be associated with an increased microvascular flap thrombosis incidence rate. Determined polymorphism could be considered as a genetic marker associated with microvascular flap thrombosis development. To confirm the results of this study, the data should be replicated in a greater sample size.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    URL: Article
    DOI: 10.3390/medicina55090563
    Language: English
    Publisher: MDPI AG
    Publication Date: 2019
    detail.hit.zdb_id: 2088820-X
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  • 5
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    Near Infrared Spectroscopy Based Clinical Algorithm Applicability During Spinal Neurosurgery and Postoperative Cognitive Disturbances
    MDPI AG ; 2019
    In:  Medicina Vol. 55, No. 5 ( 2019-05-21), p. 179-
    Details
    In: Medicina, MDPI AG, Vol. 55, No. 5 ( 2019-05-21), p. 179-
    Abstract: Background and Objectives: Postoperative cognitive disturbances (POCD) can significantly alter postoperative recovery. Inadequate intraoperative cerebral oxygen supply is one of the inciting causes of POCD. Near-infrared spectroscopy (NIRS) devices monitor cerebral oxygen saturation continuously and can help to guide intraoperative patient management. The aim of the study was to evaluate the applicability of the NIRS-based clinical algorithm during spinal neurosurgery and to find out whether it can influence postoperative cognitive performance. Materials and Methods: Thirty four patients scheduled for spinal neurosurgery were randomized into a study group (n = 23) and a control group (n = 11). We monitored regional cerebral oxygen saturation (rScO2) throughout surgery, using a NIRS device (INVOS 4100). If rScO2 dropped bilaterally or unilaterally by more than 20% from baseline values, or under an absolute value of 50%, the NIRS-based algorithm was initiated in the study group. In the control group, rScO2 was monitored blindly. To evaluate cognitive function, Montreal-Cognitive Assessment (MoCA) scale was used in both groups before and after the surgery. Results: In the study group, rScO2 dropped below the threshold in three patients and the NIRS-based algorithm was activated. Firstly, we verified correct positioning of the head; secondly, we increased mean systemic arterial pressure in the three patients by injecting repeated intravenous bolus doses of Ephedrine, ultimately resulting in an rScO2 increase above the approved threshold level. None of the three patients showed POCD. In the control group, one patient showed a drop in rScO2 of 34% from baseline and presented with a POCD. RScO2 drop occurred with other stable intraoperative measurements. Conclusions: A significant rScO2 drop may occur during spinal surgery in prone position despite other intraoperative measurements remaining stable, allowing it to stay otherwise unrecognized. Use of the NIRS-based clinical algorithm can help to avoid POCD in patients after spinal surgery.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    URL: Article
    DOI: 10.3390/medicina55050179
    Language: English
    Publisher: MDPI AG
    Publication Date: 2019
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  • 6
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    An Overview of Treatments for Congenital Forearm Longitudinal Deficiencies
    Walter de Gruyter GmbH ; 2014
    In:  Acta Chirurgica Latviensis Vol. 14, No. 2 ( 2014-12-1), p. 24-30
    Details
    In: Acta Chirurgica Latviensis, Walter de Gruyter GmbH, Vol. 14, No. 2 ( 2014-12-1), p. 24-30
    Abstract: Introduction. Congenital anomalies are rare, affecting 1-2% of new-borns and only 10% of them have upper limb defects. Incidence of forearm longitudinal deficiencies is 1:55 000-1:100 000 live births which means that 1 case in every two to four years can be expected in Latvia. Centralisation surgical procedure was the main treatment option until 2008, but it had the worst functional outcome (as literature data also show). Starting from 2010, several new surgical techniques like microvascular metatarsophalangeal joint transfer, epiphyseal fibula flap transfer and wrist radialisation had been performed in the Microsurgery Centre of Latvia. Aim of the study. A retrospective study to collect and assess functional outcomes of different types of surgeries. Material and Methods. 5 patients (7 hands) with radial club hand deformity, one ulnar club hand deformity and one ulnar dimelia were treated in the Microsurgery Centre of Latvia from 2012 to 2014. The Paediatric Evaluation of Disability Inventory (PEDI) was used to evaluate functional outcome in children. ROM (range of motion), pinch and grasp forces were measured to establish wrist motion and stability. Visual analogue scale (VAS) was used to evaluate parents’ satisfaction. Results. 3 patients (5 hands) were selected for the trial. Two patients (3 hands) were not evaluated as thumb reconstruction is not done yet. Patients had a small (10-25°) reoccurrence of radial deviation after centralisation and radialisation procedures, whereas MTP (metatarsophalangeal) joint transfer patients had straight wrists. Wrist joint functionality in MTP patients was following: extension of 10°-35° and flexion of 20°-90°. In MTP transfer patients, PEDI score was 56-58 for daily activities (normal score – 50), 69-70 for mobility (normal score – 63). VAS score was greater for MTP joint transfer patients. Conclusion. Radial and ulnar deficiencies are rare and reconstructions should be done at age 2 - 4 years, because late reconstructions are more complicated due to the stiffness of the radial fingers. Radialisation procedure is the first choice for wrist stabilization, but, in some cases, MTP joint transfer or vascularised fibular head transfer can provide a better functional outcome in radial club hand patients.
    Type of Medium: Online Resource
    ISSN: 1407-981X
    URL: Article
    DOI: 10.1515/chilat-2015-0005
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2014
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  • 7
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    Perineural Administration of Dexmedetomidine in Axillary Brachial Plexus Block Provides Safe and Comfortable Sedation: A Randomized Clinical Trial
    Frontiers Media SA ; 2022
    In:  Frontiers in Medicine Vol. 9 ( 2022-5-17)
    Details
    In: Frontiers in Medicine, Frontiers Media SA, Vol. 9 ( 2022-5-17)
    Abstract: Dexmedetomidine prolongs the duration of regional block while its systemic sedative effect when administered perineurally is unknown. We aimed to evaluate the systemic sedative effect of perineural dexmedetomidine in patients after axillary brachial plexus block (ABPB). This single-blinded prospective randomized control trial included 80 patients undergoing wrist surgery receiving ABPB. Patients were randomized into two groups – Control group (CG, N = 40) and dexmedetomidine group (DG, N = 40). Both groups received ABPB with 20 ml of 0.5% Bupivacaine and 10 ml of 2% Lidocaine. Additionally, patients in DG received 100 mcg of dexmedetomidine perineurally. Depth of sedation was evaluated using Narcontrend Index (NI) and Ramsay Sedation Scale (RSS) immediately after ABPB and in several time points up to 120 min. Duration of block as well as patient satisfaction with sedation was evaluated using a postoperative survey. Our results showed that NI and RSS statistically differed between groups, presenting a deeper level of sedation during the first 90 min in DG compared to controls, P & lt; 0.001. In the first 10 to 60 min after ABPB the median RSS was 4 (IQR within median) and median NI was 60 (IQR 44–80) in DG group, in contrast to CG patients where median RSS was 2 (IQR within median) and median NI was 97 (IQR 96–98) throughout surgery. The level of sedation became equal in both groups 90 and 120 min after ABPB when the median NI value was 98 (97–99) in DG and 97.5 (97–98) in CG, P = 0.276, and the median RSS was 2 (IQR within median) in both groups, P = 0.128. No significant intergroup differences in hemodynamic or respiratory parameters were found. Patients in DG expressed satisfaction with sedation and 86.5% noted that the sensation was similar to ordinary sleep. In DG mean duration of motor block was 13.5 ± 2.1 h and sensory block was 12.7 ± 2.8 h which was significantly longer compared to CG 6.3 ± 1.5 h, P & lt; 0.001 and 6.4 ± 1.8 h, P & lt; 0.001. We found that beside prolongation of analgesia, perineural administration of dexmedetomidine might provide rather safe and comfortable sedation with no significant effect on hemodynamic or respiratory stability and yields a high level of patient satisfaction.
    Type of Medium: Online Resource
    ISSN: 2296-858X
    URL: Article
    DOI: 10.3389/fmed.2022.834778
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2775999-4
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  • 8
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    The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 10 ( 2022-05-11), p. 2710-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 10 ( 2022-05-11), p. 2710-
    Abstract: Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p 〈 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p 〈 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p 〈 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p 〈 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p 〈 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p 〈 0.001), and ARDS (3.3, p 〈 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11102710
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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  • 9
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    The Controlling Nutritional Status (CONUT) Score for Prediction of Microvascular Flap Complications in Reconstructive Surgery
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 14 ( 2023-07-20), p. 4794-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 14 ( 2023-07-20), p. 4794-
    Abstract: Microvascular flap surgery is a widely acknowledged procedure for significant defect reconstruction. Multiple flap complication risk factors have been identified, yet there are limited data on laboratory biomarkers for the prediction of flap loss. The controlling nutritional status (CONUT) score has demonstrated good postoperative outcome assessment ability in diverse surgical populations. We aim to assess the predictive value of the CONUT score for complications in microvascular flap surgery. This prospective cohort study includes 72 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws for analysis of full blood count, total plasma cholesterol, and albumin concentrations were collected on the day of surgery before crystalloid infusion. Postoperative data on flap complications and duration of hospitalization were obtained. The overall complication rate was 15.2%. True flap loss with vascular compromise occurred in 5.6%. No differences in flap complications were found between different areas of reconstruction, anatomical flap types, or indications for surgery. Obesity was more common in patients with flap complications (p = 0.01). The CONUT score had an AUC of 0.813 (0.659–0.967, p = 0.012) for predicting complications other than true flap loss due to vascular compromise. A CONUT score 〉 2 was indicated as optimal during cut-off analysis (p = 0.022). Patients with flap complications had a longer duration of hospitalization (13.55, 10.99–16.11 vs. 25.38, 14.82–35.93; p = 0.004). Our findings indicate that the CONUT score has considerable predictive value in microvascular flap surgery.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12144794
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
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  • 10
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    Inherited Thrombophilias in Thrombosis Advancement in Microvascular Flap Surgery
    Walter de Gruyter GmbH ; 2021
    In:  Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. Vol. 75, No. 2 ( 2021-04-01), p. 113-120
    Details
    In: Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences., Walter de Gruyter GmbH, Vol. 75, No. 2 ( 2021-04-01), p. 113-120
    Abstract: Microvascular flap surgery is a reliable method for reconstructive surgery. To avoid and foresee free flap thrombosis advancement after microvascular flap surgery, patient assessment, flawless surgical technique, and eligible perioperative care are pivotal. In this prospective observational study, we aimed to elucidate the most common inherited single nucleotide polymorphisms (SNPs) attributable to free flap thrombosis. A total of 152 patients undergoing microvascular flap surgery during the study period of 2016–2019 were analysed for five SNPs: rs6025 in Factor V Leiden (FVL) gene, rs1799963 in Factor II (FII) gene, rs2066865 in Fibrinogen Gamma Chain gene (FGG), rs2227589 in SERPINC 1 gene and rs1801133 in Methylene Tetrahydrofolate Reductase (MTHFR) gene. Activated protein C resistance (aPCR), prothrombin, antithrombin (AT), fibrinogen and homocysteine plasma levels were measured to determine association with the analysed SNPs and with free flap thrombosis advancement. Our preliminary results show that carriers of FVL mutation were associated with aPCR, as we observed significantly lower aPCR plasma levels in carriers of genotype C/T, as compared to C/C; p = 0.006 (CI 95%, 0.44 to 1.19). Additionally, mean fibrinogen plasma levels were higher in carriers of FGC gene rs2066865 genotype A/A (5.6 ± 1.81 g/l), as compared to G/A and G/G; p = 0.04 (CI 95%, 0.007 to 1.09); p = 0.004 (CI 95%, 0.48 to 2.49), respectively. The study group included 12 patients (7.9%) with free flap thrombosis. For one patient free flap thrombosis advancement might have been related to the rs6025T – FVL mutation with a PCR plasma level 1.21. Lower aPCR levels was associated with carriers of FVL rs6025 C/T and higher fibrinogen plasma levels with carriers of FGG rs2066865 A/A, suggesting that these genotypes might predict higher free flap thrombosis risk, but we found no significant association between analysed SNPs and free flap thrombosis advancement.
    Type of Medium: Online Resource
    ISSN: 1407-009X
    URL: Article
    DOI: 10.2478/prolas-2021-0018
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2021
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