Dataset Information

The "Motionless Gastrocnemius": A Reliable Sign for Safe Graft Harvesting.

ABSTRACT: Difficulties in graft harvesting of the hamstring have been the topic of many studies. These difficulties are related to the aponeurotic or fibrous attachments of the hamstrings with the medial head of the gastrocnemius muscle, soleus muscle, and leg fascia. Freeing the graft from these attachments is important because insufficient release prior to stripper insertion can lead to premature transection or amputation. We describe a reliable intraoperative physical examination sign to help understand the sufficient amount by which a tendon graft needs to be released prior to stripper insertion. The presence of the motionless gastrocnemius ("motionless gastroc") phenomenon is used in our clinic as a sign that the grafts have been sufficiently freed and that a tendon stripper can be used without fear of transection or graft amputation.

SUBMITTER: Fırat A

PROVIDER: S-EPMC7768048 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The "Motionless Gastrocnemius": A Reliable Sign for Safe Graft Harvesting.

Fırat Ahmet A Veizi Enejd E Çepni Şahin Ş Subaşı İzzet Özay İÖ Kılıçarslan Kasım K

Arthroscopy techniques 20201116 12

Difficulties in graft harvesting of the hamstring have been the topic of many studies. These difficulties are related to the aponeurotic or fibrous attachments of the hamstrings with the medial head of the gastrocnemius muscle, soleus muscle, and leg fascia. Freeing the graft from these attachments is important because insufficient release prior to stripper insertion can lead to premature transection or amputation. We describe a reliable intraoperative physical examination sign to help understan ...[more]

PMID: 33381395

Similar Datasets

Project description:BackgroundEndoscopic vein harvesting (EVH) is the standard of care for coronary artery bypass grafting (CABG) in the United States, but recent comparisons with open harvesting suggest that conduit quality and outcomes may be compromised in EVH. To test the hypothesis that problems with EVH may relate to its learning curve and conduit quality, we analyzed the quality and early function of conduits procured by technicians with varying experience in EVH.MethodsExperienced (more than 900 cases, n=55 patients) and novice (less than 100 cases, n=30 patients) technicians performed EVH during CABG. Subsequently, optical coherence tomography (OCT) was used to examine the conduits for vascular injury, with segments identified as injured being further examined for gene expression with an array of genes related to tissue injury. Conduit diameter was measured intra- and postoperatively (day 5 and 6 months, respectively) with OCT and computed tomographic angiography.ResultsEndoscopic vein harvesting by novice harvesters resulted in a greater number of discrete graft injuries and greater expression of tissue-injury genes than EVH done by experienced harvesters. Regression analysis revealed an association between shear stress and early dilation of engrafted vessels (positive remodeling) (R2=0.48, p<0.01). Injured veins showed blunted positive remodeling at 5 days after harvesting and a greater degree of late lumen loss at 6 months.ConclusionsUnder normal conditions, intraluminal shear stress leads to positive remodeling of vein grafts during the first postoperative week. Injury to conduits, a frequent sequela of the learning curve for EVH, was a predictor of early graft failure and of blunted positive remodeling and greater negative remodeling of endoscopically harvested vein grafts. Given the current annual volume of cases in which EVH is used, rigorous monitoring of the learning curve for this procedure represents an important and unrecognized issue in public health.

Project description:BackgroundHarvesting bone graft (BG) from the intramedullary canal to treat bone defects is largely conducted using the Reamer-Irrigator-Aspirator (RIA) system. The RIA system uses irrigation fluid during harvesting, which may result in washout of osteoinductive factors. Here, we propose a new harvesting technology dedicated to improving BG collection without the potential washout effect of osteoinductive factors associated with irrigation fluid. This novel technology involves the conceptual approach of first aspirating the bone marrow (BM) with a novel aspirator prototype, followed by reaming with standard reamers and collecting the bone chips with the aspirator (reaming-aspiration method, R-A method). The aim of this study was to assess the harvesting efficacy and osteoinductive profile of the BG harvested with RIA 2 system (RIA 2 group) compared to the novel harvesting concept (aspirator + R-A method, ARA group).MethodsPre-planning computed tomography (CT) imaging was conducted on 16 sheep to determine the femoral isthmus canal diameter. In this non-recovery study, sheep were divided into two groups: RIA 2 group (n = 8) and ARA group (n = 8). We measured BG weight collected from left femur and determined femoral cortical bone volume reduction in postoperative CT imaging. Growth factor and inflammatory cytokine amounts of the BGs were quantified using enzyme-linked immunosorbent assay (ELISA) methods.ResultsThe use of the stand-alone novel aspirator in BM collection, and in harvesting BG when the aspirator is used in conjunction with sequential reaming (R-A method) was proven feasible. ELISA results showed that the collected BG contained relevant amounts of growth factors and inflammatory cytokines in both the RIA 2 and the ARA group.ConclusionsHere, we present the first results of an innovative concept for harvesting intramedullary BG. It is a prototype of a novel aspirator technology that enables the stepwise harvesting of first BM and subsequent bone chips from the intramedullary canal of long bones. Both the BG collected with the RIA 2 system and the aspirator prototype had the capacity to preserve the BG's osteoinductive microenvironment. Future in vivo studies are required to confirm the bone regenerative capacity of BG harvested with the innovative harvesting technology.

Dataset Information

The "Motionless Gastrocnemius": A Reliable Sign for Safe Graft Harvesting.

Publications

The "Motionless Gastrocnemius": A Reliable Sign for Safe Graft Harvesting.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets