Blood circulation in the fingers is aggravated after creating a vascular access for dialysis: assessment using skin perfusion pressure.

Internal vascular shunts for haemodialysis can cause different complications. One of the most serious complications is steal syndrome, which can result in disturbed peripheral circulation causing finger necrosis and lead to amputation. Thus, prevention of these complications is important. Measurement of skin perfusion pressure (SPP) has been used in various clinical settings, including wound-healing management, and its usefulness has been increasingly unveiled. The present study was undertaken to evaluate changes in haemodynamics after internal shunt creation by measuring SPP of the thumb and the little finger before and after surgery in five patients undergoing shunt surgery using the radial artery and the cephalic vein. The study revealed average changes of -22.8 mmHg in thumb SPP. The change in the thumb was statistically significant (p < 0.05). If the effect of surgery and the threshold for wound healing are taken into account, the present results indicate the necessity to pay extra attention to fingers with extremely low preoperative SPP values. For the prevention of serious disturbances of peripheral circulation (e.g. steal syndrome), routine preoperative SPP measurement seems effective for screening of high-risk patients.

Extended preseptal fat resection in Asian blepharoplasty.

The thickness of the upper eyelid is a bothersome condition that can be alleviated by blepharoplasty in Asians. Preseptal fat lies widely deep to the orbicularis oculi in the lower part of the upper eyelid, and the retro-orbicularis oculus fat (ROOF) pad lies in the lateral supraorbital area. We demonstrate the effectiveness of preseptal fat resection (PSFR) extended with ROOF resection in Asian patients. Three levels of PSFR were carried out in 258 eyelids of 129 Asian patients in conjunction with bilateral blepharoplasty: partial PSFR in 84 eyelids, total PSFR in 86, and extended PSFR that included ROOF resection in 68. The series revealed that PSFR was effective in reducing the thickness and heaviness of the eyelid, without major complications. PSFR including ROOF resection is an optional adjunct for Asian patients undergoing blepharoplasty. Nonetheless, the function of the grinding structures in the upper eyelid should be appropriately preserved.