Purpose: The wrist, elbow, and axillae are recipient sites for vascularized lymph node transfer (VLNT) in upper extremity lymphedema. To the best of our knowledge, the possibility of the forearm as a recipient site for the VLNT has not been extensively investigated. We introduced a novel recipient site and surgical technique for VLNT in the distal upper extremity without a skin paddle.Methods: Between January 2018 and February 2019, five consecutive patients underwent VLNT for upper extremity lymphedema. A vascularized supraclavicular lymph node was harvested and transferred to the mid-forearm of the lymphedematous limb. Radial artery, venae comitantes, and superficial vein were used as recipient vessels. Outcome was assessed by upper limb circumference and volume.Results: All flaps survived without any donor-site morbidity. All patients reported symptom improvement. Mean circumference and volume at 3, 6, and 12 months after VLNT were reduced statistically significantly (p<0.05). Volume differential reduction was significant (p=0.005), showing an increasing tendency (p=0.050).Conclusion: The forearm appears to be an excellent recipient site owing to its aesthetic and surgical benefits.
Study Objectives: This study aimed to evaluate the correlation between serial echocardiography findings and return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) and to examine whether echocardiographic cardiac standstill duration can be used to predict ROSC.Methods: This was a prospective observational study of non-consecutive nontrauma adult patients with OHCA. Echocardiography was performed every 2 minutes during a pulse check for <10 seconds throughout the resuscitation effort managed according to advanced life support treatment guidelines. Echocardiography findings were recorded as video clips.Results: Forty-eight patients were enrolled in the study. Serial echocardiographic cardiac standstill duration in the ROSC and no ROSC groups were 2.86 AE 2.07 minutes versus 20.30 AE 8.42 minutes, respectively (p < 0.001). Cardiac standstill duration !10 minutes predicted non-ROSC with a sensitivity of 90.0%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 93.3%. A receiver operating characteristic curve was generated to determine the accuracy of serial echocardiographic cardiac standstill duration for predicting no ROSC. The area under the curve was 0.991 (p < 0.000).Conclusion: In all patients with serial echocardiographic cardiac standstill !10 minutes, no patients had ROSC. These results displayed compelling test performance and discrimination ability for subjects with and without ROSC. Our study is suggestive, and it warrants further study.
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