Background MRI has been used to acutely visualize radiofrequency (RF) ablation lesions but its accuracy in predicting chronic lesion size is unknown. The main goal of this study was to characterize different areas of enhancement in late gadolinium enhancement (LGE) MRI done immediately after ablation to predict acute edema and chronic lesion size. Methods and Results In a canine model (n=10), ventricular RF lesions were created, using ThermoCool SmartTouch (Biosense Webster) catheter. All animals underwent MRI (LGE and T2-weighted (T2w) edema imaging), immediately after ablation and after 1, 2, 4 and 8 weeks. Edema, microvascular obstruction (MVO) and enhanced volumes were identified in MRI and normalized to chronic histological volume. Immediately after contrast administration, the MVO region was 3.2 +/− 1.1 times larger than the chronic lesion volume in acute MRI. Even 60 mins after contrast administration, edema was 8.73 +/− 3.31 times and the enhanced area 6.14 +/− 2.74 times the chronic lesion volume. Exponential fit to the MVO volume was found to be the best predictor of chronic lesion volume at 26.14 (95% prediction interval 24.35 – 28.11) mins after contrast injection. The edema volume in LGE correlated well with edema volume in T2w MRI with an R2 of 0.99. Conclusion MVO region on acute LGE images acquired 26.1 min after contrast administration can accurately predict the chronic lesion volume. We also show that T1-weighted MRI images acquired immediately after contrast injection accurately shows edema resulting from RF ablation.
Background Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue coverage. The foot and ankle region is challenging to reconstruct for orthopaedic and plastic surgeons owing to its complex bony anatomy and unique functional demands. Therefore, identifying strategies for plastic surgery of these wounds may help guide surgeons in defining the best treatment plan. Questions/purposes We evaluated our current algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle with respect to whether (1) prophylactic or simultaneous soft tissue coverage affected wound-healing complications (secondary plastic surgery, orthopaedic hardware removal, malunion, further orthopaedic surgery, ultimate failure) and (2) postoperative referral for soft tissue management was associated with wound location, size, and orthopaedic procedure. Methods We retrospectively reviewed 112 patients who underwent elective orthopaedic foot or ankle surgery and required concomitant plastic surgery at our institution. Study end points included secondary plastic surgery procedures, hardware removal for infection, foot or ankle malunion, further orthopaedic surgery, and wound-healing failure as defined by a chronic nonhealing wound or need for amputation. Minimum followup was 0.6 months (mean, 24.9 months; range, 0.6-197 months). Four patients were lost to complete followup. We developed an algorithm that centers on two critical points of care: preoperative evaluation by the orthopaedic surgeon and evaluation and treatment by the plastic surgeon after referral.
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