Effect of vasopressor use on digit survival after replantation and revascularization-A large retrospective cohort study.

PURPOSE: Despite the common use of intraoperative vasopressors in hand microsurgery, the association between intraoperative vasopressor use and digital replant failure has not yet been examined. Our study aims to examine the association between intraoperative vasopressor use (phenylephrine and/or ephedrine) and postoperative digital failure of replanted or revascularized digits. METHODS: All patients from a single tertiary hand center who underwent unilateral digital replantation or revascularization procedures between 2005 and 2016 were included in this retrospective cohort study. The relationship between intraoperative vasopressors used to maintain hemodynamic stability and digit failure was then evaluated using logistic regression. Specifically, phenylephrine (total dose 10-3,600 mcg) and ephedrine (5-110 mg) use were evaluated. RESULTS: During the study period, 281 patients underwent digital replantation or revascularization. Of those, 86 (31%) were given an intraoperative vasopressor. Digit failure was more likely in patients with crush or avulsion injuries compared to clean-cut mechanism (odds ratio [OR] 2.02, p = .02), and in patients with replantation (OR 7.85, p < .0001) as compared to revascularization procedures. Using multivariate logistic regression adjusting for age, sex, smoking status, comorbidities, number of digits injured, injury type, and procedure type, the odds of digital failure with vasopressor use were not increased (p = .84). When evaluating vasopressors used after tourniquet deflation, failure increased with ephedrine use (OR = 2.42, p = .0496) and phenylephrine use (OR = 2.21, p = .31). CONCLUSIONS: The use of vasopressors was not associated with failure if administration of vasopressors was before tourniquet deflation. The administration of vasopressors after tourniquet deflation should be cautioned.

The examination of soft tissue compliance in the thoracic region for the development of a spinal manipulation training mannequin.

PURPOSE: To determine if the soft tissue compliance of the thoracic paraspinal musculature differs based on gender and body type to help create a foam human analogue mannequin to assist in the training of spinal manipulative therapy. METHODS: 54 volunteers were grouped based on their gender and body types. In the prone position, thoracic paraspinal soft tissue compliance was measured at T1, T3 T6, T9 and T12 vertebrae levels bilaterally using a tissue compliance meter. RESULTS: There was no significant difference in tissue compliance when comparing the genders except at T1 (p=0.026). When comparing body types, significantly higher tissue compliance was found between endomorphs and the other groups. No significant difference was found between ectomorphs and mesomorphs. The compliance for the participants in this study ranged from 0.122 mm/N to 0.420 mm/N. CONCLUSION: There are significant differences in thoracic spine soft tissue compliance in healthy asymptomatic patients between genders in the upper thoracic spine, and between different body types throughout the thoracic spine. It may be beneficial to create multiple versions of practice mannequins to simulate variations amongst different patients.

OBJECTIF: Déterminer si la compliance des tissus mous de la masse musculaire thoracique paradorsale diffère selon le sexe et le type corporel afin de créer un mannequin en mousse de forme humaine pour aider à la formation en traitement par manipulation dorsale. MÉTHODOLOGIE: On a regroupé 54 volontaires en fonction de leur sexe et de leur type corporel. En position allongée, on a mesuré la compliance des tissus mous thoraciques paradorsaux au niveau des vertèbres T1, T3, T6, T9 et T12 bilatéralement à l'aide d'un dispositif de mesure de compliance. RÉSULTATS: Il n'y a pas de grande différence sur le plan de la compliance des tissus lorsqu'on compare les sexes, sauf à la vertèbre T1 (p = 0,026). En comparant les types corporels, une compliance des tissus bien plus élevée a été remarquée chez les endomorphes par rapport aux autres groupes. Il n'y a pas de différence importante entre les ectomorphes et les endomorphes. La compliance pour les participants à cette étude allait de 0,122 mm/N à 0,420 mm/N. CONCLUSION: Il existe de grandes différences entre la compliance des tissus mous thoraciques dorsaux chez les patients en santé asymptomatiques entre les sexes dans la colonne thoracique supérieure et entre les différents types corporels dans toute la colonne thoracique. Il peut être bénéfique de créer plusieurs versions de mannequins de pratique pour simuler les variations chez les différents patients.