Patients undergoing cardiothoracic surgery, especially open cardiac procedures requiring cardiopulmonary bypass, are exposed to several alterations in primary and secondary hemostasis. These derangements are associated with increased microvascular bleeding that is refractory to conventional surgical maneuvers aimed at achieving hemostasis. This poses a technical problem for the surgeon and exposes the patient to increased morbidity from uncontrolled bleeding and any associated transfusion of blood products. Use of biosurgical hemostatic agents, specifically in patients undergoing cardiac surgery, have been shown to be safe and effective in reducing time to hemostasis, decreasing transfusion of blood products, and improving patient outcomes. Despite their merits, selection of a topical hemostat is frequently based on anecdotal experience and limited knowledge of the available agents. The prepared surgeon is familiar with these agents and can anticipate opportunities for their deployment in the setting of coagulopathy.
Posttraumatic arthritis may present challenges during total knee arthroplasty (TKA). A retained intramedullary nail may preclude the use of traditional keeled TKA tibial tray implants. We present a technique for the use of a porous tantalum, pegged tibial baseplate in TKA status post intramedullary nailing. Contraindications to this procedure include active infection, positioning of implanted hardware that might compromise TKA function, and morbidity associated with retention of the nail. Preoperative imaging, appropriate templating, and careful intraoperative examination of cut proximal tibial and peg hole surfaces are essential to optimize TKA fixation. We also present the option of a hybrid fixation method when there is concern for the quality of proximal tibial bone or proximity to the tibial intramedullary nail. Complications for this procedure are discussed, including risk of component subsidence, delayed soft-tissue healing, and increased incidence of deep infections. Although midterm data have shown promising clinical results, long-term data are still needed to assess longevity in younger, active patients.
Mycotic subclavian aneurysms are rare, and their presence typically mandates urgent repair due to the associated high risk of rupture and mortality. A multi-disciplinary team effort is of utmost importance in ensuring favorable results. In this case report, we present a 79-year-old male with a rapidly enlarging mycotic left subclavian artery aneurysm secondary to a retrosternal abscess and left sternoclavicular septic arthritis, who underwent aneurysmal exclusion, a left carotid-left axillary bypass and pectoralis muscle flap coverage with a good outcome.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.