AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Vascular Injuries in Very Small Children: An Algorithm for Diagnosis and Treatment
Institution where the work was prepared: Texas Children Hospital, Houston, TX, USA
Jamal Bullocks, MD1; Jeffrey D. Friedman, MD2; Michael Klebuc, MD2; (1)Baylor College of Medicine, (2)The Methodist Hospital
Introduction:
Vascular injuries in neonates and small children are a relatively uncommon complication of invasive catheterization procedures. From a clinical perspective,
these injuries present in the form of an ischemic limb that is typically swollen, mottled and cold to the touch. In most cases it is difficult to identify the exact
nature of the underlying injury and differentiate acute thrombosis from severe arterial spasm and/or compartment hypertension. At our institution, we have
developed an algorithmic approach to the diagnosis of these injuries so that appropriate treatment measures can be instituted.
Materials and Methods:
A retrospective review was performed on 30 patients presenting with an acutely ischemic extremity. Physical examination, color Doppler ultrasound, and close
monitoring was carried out in each case. Patients were treated with the following algorithm:
Results:
In all cases associated with a normal Doppler examination there were no instances of significant soft tissue loss despite numerous interventions for soft tissue
release. Those patients with a demonstrated occlusion of a major peripheral vessel, operative intervention provided for limb salvage in all patients despite one
postoperative death and an additional patient requiring an above knee amputation 1 year post limb salvage due to a severe limb growth disturbance.
Conclusion:
The combined use of serial clinical examinations, color Doppler ultrasound, and operative intervention has proven successful in maximizing limb salvage in children with
devastating vascular injuries. We now employ this algorithm of treatment as our standard methodology when faced with severely ischemic limbs of uncertain etiology.
A New Rat Model for Brachial Plexus Birth Injury Associated Shoulder Deformity
Institution where the work was prepared: Wake Forest University Health Sciences, Winston-Salem, NC, USA
Zhongyu Li, MD, PhD1; Jianjun Ma1; Cathy S. Carlson, PhD2; Thomas L. Smith, PhD1; L. Andrew Koman, MD1; (1)Wake Forest University Health Sciences, (2)College of
Veterinary Medicine, University of Minnesota
Aim:
The aim of this study was to establish an animal model to study brachial plexus birth palsy (BPBP) related shoulder deformity. BPBP is not uncommon, and
the result is often devastating. Clinical studies have shown that shoulder contracture occurs in at least one-third of the children who sustain BPBP with delayed
recovery and in at least two-thirds of children with incomplete recovery.
Materials and Methods:
A right side C5, C6 axotomy was performed under the microscope in 3 day old Sprague Dawley rats (n=4, male and female). The contralateral side served as a control.
The development of shoulder deformity and range of motion of shoulder were followed longitudinally for 4 months. Animals were euthanized 4 months after
surgery. Both shoulders were harvested, decalcified in formic acid, and transected in the axial plane for glenohumeral version measurement and joint histology.
Results:
All animals developed right shoulder internal rotation deformities within 4 weeks after the C5,6 axotomy. The average shoulder external rotation was 63.8%
of the control side (96±9° vs. 156±9°; p