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Journal articles on the topic 'Trunk surgery'

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Author: Grafiati
Published: 10 March 2023

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1

Kahilogullari, Gokmen, Hasan Caglar Ugur, Ayhan Comert, Ibrahim Tekdemir, and Yucel Kanpolat. "The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography." Journal of Neurosurgery 116, no. 5 (May 2012): 1024–34. http://dx.doi.org/10.3171/2012.1.jns111013.

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Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. Methods Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. Results A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk was present in 61% of cadavers and originated from a superior trunk in 55% and from an inferior trunk in 45%. Cortical branches supplying the motor cortex (precentral, central, and postcentral arteries) significantly originated from the intermediate trunk, and the diameter of the intermediate trunk significantly increased when it originated from the superior trunk. In measurements of the angles between the superior and intermediate trunks, it was found that the intermediate trunk had significant dominance in supplying the motor cortex as the angle increased. The intermediate trunk was classified into 3 types based on the angle values and the distance to the bifurcation point as Group A (pseudotrifurcation type), Group B (proximal type), and Group C (distal type). Group A trunks were seemingly closer to the trifurcation structure that has been reported on in the literature and was seen in 15%. Group B trunks were the most common type (55%), and Group C trunks were characterized as the farthest from the bifurcation point. Group C trunks also had the smallest diameter and fewest cortical branches. Similarities were found between the angles in cadaver specimens and on 3D CT cerebral angiography images. Beyond the separation point of the MCA, trunk structures always included the superior trunk and inferior trunk, and sometimes the intermediate trunk. Conclusions Interrelations of these vascular structures and their influences on the cortical branches originating from them are clinically important. The information presented in this study will ensure reliable diagnostic approaches and safer surgical interventions, particularly with MCA selective angiography.
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2

Finnerty, O., J. Carney, and J. G. McDonnell. "Trunk blocks for abdominal surgery." Anaesthesia 65 (April 2010): 76–83. http://dx.doi.org/10.1111/j.1365-2044.2009.06203.x.

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3

Chai, Paul J., Jeffrey P. Jacobs, and James A. Quintessenza. "Surgery for common arterial trunk." Cardiology in the Young 22, no. 6 (December 2012): 691–95. http://dx.doi.org/10.1017/s1047951112002016.

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AbstractSurgery for common arterial trunk has evolved over the past 30 years. Current management involves total repair during the neonatal period with excellent expected results. The presence of truncal valve insufficiency or interrupted aortic arch may increase the surgical risk for morbidity and mortality. Current therapy and management continues to evolve.
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4

Van Arsdell, Glen S., and Anthony Azakie. "Surgery for common arterial trunk." Progress in Pediatric Cardiology 15, no. 1 (June 2002): 53–58. http://dx.doi.org/10.1016/s1058-9813(02)00008-5.

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5

Umansky, Felix, Manuel Dujovny, James I. Ausman, Fernando G. Diaz, and Haresh G. Mirchandani. "Anomalies and Variations of the Middle Cerebral Artery : A Micro anatomical Study." Neurosurgery 22, no. 6P1-P2 (June 1, 1988): 1023–27. http://dx.doi.org/10.1227/00006123-198806010-00008.

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Abstract The microvascular anatomy of the main trunk and divisions of the middle cerebral artery was studied in 104 unfixed brain hemispheres injected with polyester resin and dissected under the operating microscope. The following anomalies and variations of the middle cerebral artery were found: fenestration (1 case; 1%), located on the first 4 mm of the main trunk of the middle cerebral artery; duplication (1 case; 1%). with vessels arising from the internal carotid artery; accessory middle cerebral artery (2 cases; 2%). originating on the A, segment of the anterior cerebral artery; single-trunk type of middle cerebral artery (4 cases; 4%), with no division of its main trunk; quadrifurcation (4 cases; 4%), in which the main trunk of the middle cerebral artery divided into four secondary trunks. The clinical implications of these anatomical findings are discussed, and photographs of representative specimens illustrate the anomalies.
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6

Iaconetta, Giorgio, Enrico Tessitore, and Madjid Samii. "Duplicated abducent nerve and its course: microanatomical study and surgery-related considerations." Journal of Neurosurgery 95, no. 5 (November 2001): 853–58. http://dx.doi.org/10.3171/jns.2001.95.5.0853.

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Object. The anatomy of the abducent nerve is well known; its duplication (ranging from 5 to 28.6%), however, has rarely been reported in the literature. The authors performed a microanatomical study in 100 cadaveric specimens (50 heads) to evaluate the prevalence of this phenomenon and to provide a clear anatomical description of the course and relationships of the nerve. The surgery-related implications of this rare anatomical variant will be highlighted. Methods. The 50 human cadaveric heads (100 specimens) were embalmed in a 10% formalin solution for 3 weeks. Fifteen of them were injected with colored neoprene latex. A duplicated abducent nerve was found in eight specimens (8%). In two (25%) of these eight specimens the nerve originated at the pontomedullary sulcus as two independent trunks: in one case the superior trunk was thicker than the inferior and in the other it was thinner. In the other six cases (75%) the nerve originated as a single trunk, splitting in two trunks into the cisternal segment: in two of them the trunks ran below the Gruber ligament, whereas in four specimens one trunk ran below and one above it. In all the specimens, the duplicated nerves fused again into the cavernous sinus, just after the posterior genu of the internal carotid artery. Conclusions. Although the presence of a duplicated abducent nerve is a rare finding, preoperative magnetic resonance imaging should be performed to rule out this possibility, thus tailoring the operation to avoid postoperative deficits.
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7

De Ru, J. Alexander, Peter Paul G. Van Benthem, Ronald L. A. W. Bleys, Herman Lubsen, and Gert-Jan Hordijk. "Landmarks for parotid gland surgery." Journal of Laryngology & Otology 115, no. 2 (February 2001): 122–25. http://dx.doi.org/10.1258/0022215011907721.

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Many surgical landmarks have been suggested to help the surgeon identify the facial nerve when performing parotid gland surgery. There is no conclusive evidence that any one landmark is better than the rest. In this study distances from the most frequently used surgical landmarks to the main trunk of the facial nerve were measured in 30 halves of cadaver heads. Two ENT surgeons assessed the best landmark in each case. The tympanomastoid suture was nearest to the main trunk and was therefore considered the most reliable landmark. Its average distance to the main trunk of the facial nerve was 2.7 mm. This result was consistent with the subjective best score given by two ENT surgeons.
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8

BURGE, P. D., and D. J. SHEWRING. "Vascularized Pedicle Graft of the Lower Trunk for Reconstruction of the Brachial Plexus." Journal of Hand Surgery 20, no. 2 (April 1995): 215–17. http://dx.doi.org/10.1016/s0266-7681(05)80054-3.

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The middle trunk of an injured brachial plexus was reconstructed using a vascularized graft of the lower trunk, which was expendable because of irreparable damage to the C8 and T1 nerve roots. The graft was transferred on a vascular pedicle of mesoneurium. Useful recovery was achieved at 3 years. This technique helps to overcome the problems of limited supply and secondary sensory deficit of grafts from peripheral nerves, but is possible only if the plexus is explored early, before mobilization and transfer of nerve trunks is precluded by scarring.
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9

Burkholder, Lee M., David A. Houlden, Rajiv Midha, Erin Weiss, and Marco Vennettilli. "Neurogenic motor evoked potentials: role in brachial plexus surgery." Neurosurgical Focus 16, no. 5 (May 2004): 607–10. http://dx.doi.org/10.3171/foc.2004.16.5.17.

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✓ Peripheral nerve graft repair after severe brachial plexus injury is futile if there is degeneration of motor fibers in the proximal nerve stump to which the graft must be attached. Traditional intraoperative neurophysiological assessment methods like nerve action potential (NAP) and somatosensory evoked potential (SSEP) monitoring have been used to evaluate proximal nerve stump integrity, but these methods do not allow evaluation of the integrity of motor fibers back to the anterior horn cell. Consequently, the authors used transcranial electrical stimulation and recorded neurogenic motor evoked potentials (MEPs) directly from the brachial plexus in a patient undergoing surgical repair of a complete upper brachial plexus injury (Erb palsy) to assess the functional continuity of motor fibers. In addition, selected elements of the brachial plexus were directly stimulated, and NAPs were recorded. Finally, SSEPs were recorded from the scalp after stimulation of selected elements of the brachial plexus. Neurogenic MEPs were present from the medial cord of the brachial plexus, but not the middle or upper trunk; NAPs were present from the lateral and posterior cords after middle trunk stimulation, but absent after upper trunk stimulation; and SSEPs were present after medial cord stimulation but absent after stimulation of the upper and middle trunks. For the first time, neurogenic MEPs were coupled with NAPs and SSEPs to evaluate successfully the functional status of motor fibers back to the anterior horn cell for accurate localization of the lesion sites.
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10

Burkholder, Lee M., David A. Houlden, Rajiv Midha, Erin Weiss, and Marco Vennettilli. "Neurogenic motor evoked potentials: role in brachial plexus surgery." Journal of Neurosurgery 98, no. 3 (March 2003): 607–10. http://dx.doi.org/10.3171/jns.2003.98.3.0607.

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✓ Peripheral nerve graft repair after severe brachial plexus injury is futile if there is degeneration of motor fibers in the proximal nerve stump to which the graft must be attached. Traditional intraoperative neurophysiological assessment methods like nerve action potential (NAP) and somatosensory evoked potential (SSEP) monitoring have been used to evaluate proximal nerve stump integrity, but these methods do not allow evaluation of the integrity of motor fibers back to the anterior horn cell. Consequently, the authors used transcranial electrical stimulation and recorded neurogenic motor evoked potentials (MEPs) directly from the brachial plexus in a patient undergoing surgical repair of a complete upper brachial plexus injury (Erb palsy) to assess the functional continuity of motor fibers. In addition, selected elements of the brachial plexus were directly stimulated, and NAPs were recorded. Finally, SSEPs were recorded from the scalp after stimulation of selected elements of the brachial plexus. Neurogenic MEPs were present from the medial cord of the brachial plexus, but not the middle or upper trunk; NAPs were present from the lateral and posterior cords after middle trunk stimulation, but absent after upper trunk stimulation; and SSEPs were present after medial cord stimulation but absent after stimulation of the upper and middle trunks. For the first time, neurogenic MEPs were coupled with NAPs and SSEPs to evaluate successfully the functional status of motor fibers back to the anterior horn cell for accurate localization of the lesion sites.
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11

Kim, David H., Yi Lin, Jonathan C. Beathe, Jiabin Liu, Joseph A. Oxendine, Stephen C. Haskins, Michael C. Ho, et al. "Superior Trunk Block." Anesthesiology 131, no. 3 (September 1, 2019): 521–33. http://dx.doi.org/10.1097/aln.0000000000002841.

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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery. The high incidence of hemidiaphragmatic paralysis associated with the block, however, precludes its use among patients with compromised pulmonary function. To address this issue, recent studies have investigated phrenic-sparing alternatives that provide analgesia. None, however, have been able to reliably demonstrate surgical anesthesia without significant risk for hemidiaphragmatic paralysis. The utility of the superior trunk block has yet to be studied. The hypothesis was that compared with the interscalene block, the superior trunk block will provide noninferior surgical anesthesia and analgesia while sparing the phrenic nerve. Methods This randomized controlled trial included 126 patients undergoing arthroscopic ambulatory shoulder surgery. Patients either received a superior trunk block (n = 63) or an interscalene block (n = 63). The primary outcomes were the incidence of hemidiaphragmatic paralysis and worst pain score in the recovery room. Ultrasound was used to assess for hemidiaphragmatic paralysis. Secondary outcomes included noninvasively measured parameters of respiratory function, opioid consumption, handgrip strength, adverse effects, and patient satisfaction. Results The superior trunk group had a significantly lower incidence of hemidiaphragmatic paralysis compared with the interscalene group (3 of 62 [4.8%] vs. 45 of 63 [71.4%]; P < 0.001, adjusted odds ratio 0.02 [95% CI, 0.01, 0.07]), whereas the worst pain scores in the recovery room were noninferior (0 [0, 2] vs. 0 [0, 3]; P = 0.951). The superior trunk group were more satisfied, had unaffected respiratory parameters, and had a lower incidence of hoarseness. No difference in handgrip strength or opioid consumption were detected. Superior trunk block was associated with lower worst pain scores on postoperative day 1. Conclusions Compared with the interscalene block, the superior trunk block provides noninferior surgical anesthesia while preserving diaphragmatic function. The superior trunk block may therefore be considered an alternative to traditional interscalene block for shoulder surgery.
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12

Losanoff, Julian E., J. Michael Millis, Robert C. Harland, and Giuliano Testa. "Hepato-Spleno-Mesenteric Trunk." Journal of the American College of Surgeons 204, no. 3 (March 2007): 511. http://dx.doi.org/10.1016/j.jamcollsurg.2006.07.045.

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13

Agarwal, Akhilesh, Anshu Agarwal, B. D. Sil, Chandan R. Choudhury, and Saptarshi Bhattacharya. "Large Neurofibroma of Trunk." Indian Journal of Surgery 73, no. 3 (February 1, 2011): 210–11. http://dx.doi.org/10.1007/s12262-010-0129-x.

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14

Koehler, Linda A., and Harvey N. Mayrovitz. "Tissue Dielectric Constant Measures in Women With and Without Clinical Trunk Lymphedema Following Breast Cancer Surgery: A 78-Week Longitudinal Study." Physical Therapy 100, no. 8 (May 7, 2020): 1384–92. http://dx.doi.org/10.1093/ptj/pzaa080.

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Abstract Objective Following breast cancer surgery with lymph node removal, women are at risk of developing lymphedema in the upper extremity or trunk. Currently, trunk lymphedema diagnosis relies on a clinical assessment because no quantifiable standard method exists. Tissue dielectric constant (TDC) values are quantifiable measures of localized skin tissue water and may be able to detect trunk lymphedema. The goal of this study was to (1) compare parameters derived from TDC measurements with those derived from clinically accepted criteria for trunk lymphedema in women following breast cancer surgery and (2) explore the potential utility of TDC to detect trunk lymphedema early in its progression. Methods This prospective longitudinal study, a secondary analysis from a larger study, observed women with and without clinically determined truncal lymphedema following breast cancer surgery. TDC was measured on the lateral trunk wall at post-surgery weeks 2, 4, 12, and 78 in women who had surgical breast cancer treatment with lymph node removal. Clinical assessment for trunk lymphedema was determined at 78 weeks by a lymphedema expert. Comparison of TDC measurements in women with and without clinical trunk lymphedema was analyzed. Results Clinical assessment identified trunk lymphedema in 15 out of 32 women at 78 weeks. These women had TDC ratios statistically higher than women without truncal lymphedema. Conclusion The overall findings indicate that TDC has the ability to quantify trunk lymphedema and might be valuable in early detection. Impact TDC may be a beneficial tool in the early detection of breast cancer–related trunk lymphedema, which could trigger intervention. Lay Summary A new device may help recognize trunk lymphedema in patients with breast cancer so they could receive appropriate treatment.
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15

Svistov, Dmitriy V., Dzhamaludin M. Isaev, Aleksey I. Gaivoronskiy, Leonid I. Churikov, and Kirill V. Belyakov. "Intraoperative infrared fluorescence angiography in surgery of peripheral nerve injuries." Bulletin of the Russian Military Medical Academy 23, no. 1 (May 12, 2021): 59–66. http://dx.doi.org/10.17816/brmma61378.

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Often, when performing reconstruction of nerve trunks, between the ends of the damaged nerve, the presence of diastasis is noted, which requires significant nerve tension in order to overcome it. This, in turn, can lead to a violation of the blood supply to the nerve and damage to its ultrastructures, which leads to unsatisfactory treatment results. The possibility of using intraoperative infrared fluorescence angiography in reconstructive surgical interventions for peripheral nerve damage, in order to assess the degree of blood flow disturbance in the nerve trunk, is considered. In patients with a complete anatomical break during the operation, an attempt was made to overcome diastasis by measuring the tension force (up to 3 N) with which the nerve was affected. Infrared fluorescence angiography with indocyanine green was performed simultaneously. The obtained angiograms were analyzed, and the effect of the tension force on the change in blood flow in the nerve trunk was determined. It was found that when exposed to a force of up to 2 N, there is no significant change in the intraneural blood flow. At the same time, the effect of a force of 3 N is manifested on angiograms by a significant decrease in the volume of blood flow, which is usually due to constriction of the vessels due to their stretching. After reconstruction (microsurgical epineural suture), repeated angiography was performed to assess the safety and adequacy of blood supply to the nerve. It was revealed that the use of intraopreational angiography with indocyanin green is an affordable and easily feasible technique that allows to determine the safety and, equally important, the adequacy and efficiency of blood flow in the nerve trunk. This technique makes it possible to monitor the safety of blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, to assess the quality of comparison of nerve stumps along the axis, excluding the possibility of their "twist".
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Lagoutte, Nicolas, Olivier Facy, Boris Guiu, Claire Favier, and Nicolas Cheynel. "Celiacomesenteric trunk: a variation that must be known before aortic surgery." Clinics and Practice 1, no. 3 (September 30, 2011): 69. http://dx.doi.org/10.4081/cp.2011.e69.

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The celiac trunk and the mesenteric arteries may present variations with different clinical significance. A celiacomesenteric trunk was discovered in a patient with mesenteric ischemia and a history of aortic bypass without inferior mesenteric artery reimplantation. Despite thrombectomies and digestive resections, the patient died. Anatomic variations like celiacomesenteric trunk must be known before aortic surgery.
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17

Marinković, Slobodan, Hirohiko Gibo, Milan Milisavljević, Vuk Djulejić, and Vladimir T. Jovanović. "Microanatomy of the Intrachoroidal Vasculature of the Lateral Ventricle." Operative Neurosurgery 57, suppl_1 (July 1, 2005): 22–36. http://dx.doi.org/10.1227/01.neu.0000163479.41621.39.

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Abstract OBJECTIVE: Intraventricular surgery requires a detailed knowledge of the microanatomy of the choroid plexus vasculature. METHODS: Twenty choroid plexuses were microdissected, and two additional plexuses were prepared for microscopic examination. RESULTS: The choroid plexus was perfused primarily by the anterior choroidal artery (AChA) and the lateral posterior choroidal artery (LPChA). The AChA, which averaged 650 μm in diameter, most often (in 75% of cases) divided into the medial and lateral trunks, which averaged 450 μm in diameter. The medial trunk gave off the bush-like intrachoroidal branches, whereas the lateral trunk divided into the parallel arteries. The inferior LPChA was present in 50% of the hemispheres, both the inferior and superior LPChAs in 40%, and their common trunk in 10%. In 40%, the LPChA, which averaged 670 μm in diameter, divided into the terminal trunks, with a mean diameter of 490 μm. The anastomoses involving the trunks of the LPChA and other choroidal arteries averaged 310 μm in diameter. All primary intrachoroidal branches of the AChA and LPChA were divided into three groups. The parallel branches, which averaged from 220 to 230 μm in diameter, coursed along the lateral part of the choroid plexus. The tortuous glomus vessels, which averaged 310 μm in size, originated from the AChA (45%), the LPChA (15%), or both (40%). The bush-like vessels, with a mean diameter between 155 and 190 μm, ramified into smaller twigs, up to the intrachoroidal capillaries. CONCLUSION: The data obtained on the microanatomy of the intrachoroidal vasculature may have certain neurosurgical implications.
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Ramasastry, Sai S., Benjamin Schlechter, and Mimis Cohen. "Reconstruction Of Posterior Trunk Defects." Clinics in Plastic Surgery 22, no. 1 (January 1995): 167–85. http://dx.doi.org/10.1016/s0094-1298(20)32794-2.

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19

Mathes, David W., James F. Thornton, and Rod J. Rohrich. "Management of Posterior Trunk Defects." Plastic and Reconstructive Surgery 118, no. 3 (September 2006): 73e—83e. http://dx.doi.org/10.1097/01.prs.0000233130.93861.15.

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20

Pacetti, Andrea, Samuele Moretti, Catia Pinto, Stéphane Compant, Sibylle Farine, Christophe Bertsch, and Laura Mugnai. "Trunk Surgery as a Tool to Reduce Foliar Symptoms in Diseases of the Esca Complex and Its Influence on Vine Wood Microbiota." Journal of Fungi 7, no. 7 (June 29, 2021): 521. http://dx.doi.org/10.3390/jof7070521.

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In the last few years, trunk surgery has gained increasing attention as a method to reduce foliar symptoms typical of some of the Esca complex diseases. The technique relies on the mechanical removal of decayed wood by a chainsaw. A study on a 14-year-old Cabernet Sauvignon vineyard was carried out to validate the efficacy of trunk surgery and explore possible explanations behind it. Three levels of treatment were applied to three of the most characteristic symptoms associated with some diseases of the Esca complex, such as leaf stripe symptoms (LS), wilted shoots (WS) and apoplexy (APP). The most promising results were obtained by complete trunk surgery, where the larger decay removal allowed lower symptom re-expression. According to the wood types analyzed (decay, medium and sound wood), different changes in microbiota were observed. Alpha-diversity generally decreased for bacteria and increased for fungi. More specifically, main changes were observed for Fomitiporia mediterranea abundance that decreased considerably after trunk surgery. A possible explanation for LS symptom reduction after trunk surgery could be the microbiota shifting caused by the technique itself affecting a microbic-shared biochemical pathway involved in symptom expression.
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SIMÕES, MARCELO SIMONI, ERNANI VIANNA DE ABREU, MARCIA BALLE KAIPER, ALESSANDRO MACHADO DA SILVA, and THIANE ALEXANDRINO. "TRUNK MOBILITY AFTER MINIMALLY INVASIVE ONE-LEVEL LUMBAR INSTRUMENTATION." Coluna/Columna 15, no. 3 (September 2016): 235–37. http://dx.doi.org/10.1590/s1808-185120161503147350.

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ABSTRACT Objective: To evaluate the impact of a minimally invasive lumbar one-level fixation on trunk mobility and quality of life compared with the preoperative condition in 26 consecutive patients. Methods: The following data were collected preoperatively and postoperatively for the statistical analysis: maximal trunk extension and flexion angles, Visual Analog Scale of pain and Oswestry Disability Index scores. Results: There was improvement in all variables. Statistical significance was observed in trunk extension, pain, and Oswestry Disability Index. Although mobility in trunk flexion was higher in average values after surgery, this difference was not statistically demonstrated. Conclusion: Minimally invasive one-level lumbar fixation does not cause reduction of trunk flexibility in comparison to the mobility before surgery.
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Svistov, Dmitry Vladimirovich, Dzhamaludin Magomedrasulovich Isaev, Alexey Ivanovich Gaivoronsky, Leonid Igorevich Churikov, and Kirill Vladimirovich Belyakov. "Intraoperative fluorescent angiography with indocyanine green in surgery of peripheral nerve injuries." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 3 (March 18, 2021): 224–34. http://dx.doi.org/10.33920/med-01-2103-06.

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Despite the widespread introduction of microsurgical techniques in peripheral nerve surgery, a relatively high percentage of unsatisfactory results remains. Often, when treating patients with traumatic neuropathies, the surgeon faces the problem of diastasis between the ends of the damaged nerve. As a rule, in the presence of diastasis greater than 5 cm, it is recommended to perform inter-bundle autoneuroplasty. However, overcoming diastasis less than 5 cm may be accompanied by tension of the nerve trunk, which leads to a violation of its blood supply. In this case, the outcome of the intervention may be unsatisfactory, despite the operation performed perfectly from a technical point of view. An important factor of the outcome of surgical treatment of neuropathies of various origins is the preservation of adequate blood supply to the nerve trunk in the intraoperative period. In order to assess the blood flow in the nerve trunk, the possibility of using intraoperative fluorescent angiography for reconstructive surgical interventions on nerves was considered. In patients with a complete anatomical break of the large nerve trunk, at the moment of overcoming diastasis, intraoperative angiography of the nerve trunk was performed by intravenous administration of indocyanine green, with simultaneous registration of the tension force with which the nerve trunk was affected. In addition, fluorescent angiography was performed after the restoration of the integrity of the nerve trunk, thus assessing the safety, adequacy and effectiveness of blood flow in it. It was found that intraoperative angiography is an accessible and easily implementable technique to determine the safety and, not least, the adequacy and effectiveness of the blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, and to assess the quality of matching the stumps of the nerve axis, preventing the possibility of «torsion».
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Stelmakh, G. Ya. "The Role of Sympathetic Trunks in the Innervation of the Posterior Mediastinum Blood Vessels in Human Fetuses." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 7, no. 3 (July 2, 2022): 73–78. http://dx.doi.org/10.26693/jmbs07.03.073.

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The purpose of the study was to establish patterns of variation of the branches of the right and left sympathetic trunks in the thoracic aorta azygos and hemiazygos veins during the fetal period of human ontogenesis. Materials and methods. An anatomical study was performed on 47 human fetuses using macromicroscopic preparation of neurovascular branches under the control of binocular magnifier, vascular injection, application contrasting of prepared vessels and nerves, making 3D reconstruction models of the posterior mediastinum structures and morphometry. Results. The anatomical variability of nodes and branches of the thoracic right and left sympathetic trunks involved in the innervation of the thoracic aorta, azygos and hemiazygos veins has been established in the human fetuses of different age groups. The segmental-metameric distribution of the visceral branches of the thoracic sympathetic trunk was revealed, as well as the preservation of the segmental sympathetic innervation of the thoracic aorta, azygos and hemiazygos veins both on the left and on the right. Despite the significant progress in the study of morphological features of innervation of posterior mediastinum organs and structures, the active development of fetal surgery in recent years raises a number of questions related to the sources of sympathetic innervation of the thoracic aorta, azygos and hemiazygos veins. Conclusion. The sources of innervation of the thoracic aorta, azygos and hemiazygos veins in human fetuses are: thoracic nodes and internodal branches of the right and left sympathetic trunks; large visceral nerves; branches of the esophageal, pulmonary and cardiac plexuses; vagosympathetic trunks; collateral trunk. The number of branches to the thoracic aorta from the left sympathetic trunk is 4-16, and from the right sympathetic trunk – 3-14. The largest number of branches that enter the wall of the thoracic aorta, from the left sympathetic trunk skeletotopically determined at the level of III-VI thoracic segments, and from the right sympathetic trunk – at the level of IV-VI thoracic segments. Different skeletotopic levels of the branches of the right and left large visceral nerves are involved in the innervation of the thoracic aorta – from V to X thoracic segments. It is noted that the right and left sympathetic trunks are almost equally involved in the innervation of the azygos and hemiazygos veins. The number of sympathetic branches to the azygos vein ranges from 4 to 7, and the number of sympathetic branches to the hemiazygos vein is usually 2-4
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Saeyeldin, Ayman, Anton A. Gryaznov, Mohammad A. Zafar, Jinlin Wu, Sandip Mukherjee, Prashanth Vallabhajosyula, Bulat A. Ziganshin, and John A. Elefteriades. "Interstage mortality in two‐stage elephant trunk surgery." Journal of Cardiac Surgery 36, no. 6 (February 26, 2021): 1882–91. http://dx.doi.org/10.1111/jocs.15441.

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Krepkogorskiy, N. V., I. M. Ignatiev, R. A. Bredikhin, and I. N. Illarionova. "Tibioperoneal trunk repair in autovenous femoropopliteal bypass surgery." Kardiologiya i serdechno-sosudistaya khirurgiya 12, no. 5 (2019): 467. http://dx.doi.org/10.17116/kardio201912051467.

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26

Vaello, V., C. Pérez, P. Muñoz, A. García, J. Nuñez, A. Santana, P. Lopez, and J. Nuño. "Surgery of arterial aneurysms of the celiac trunk." HPB 23 (2021): S964—S965. http://dx.doi.org/10.1016/j.hpb.2021.08.632.

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27

Leone, A., G. Coppola, L. Di Marco, C. Amodio, G. Murana, C. Mariani, G. Barberio, D. Pacini, and R. Di Bartolomeo. "OC29 FROZEN ELEPHANT TRUNK TECHNIQUE IN AORTIC SURGERY." Journal of Cardiovascular Medicine 19 (November 2018): e3. http://dx.doi.org/10.2459/01.jcm.0000549854.44504.a6.

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28

Rigg, Bruce M. "PLASTIC SURGERY OF THE TRUNK – REDUCING BLOOD LOSS." ANZ Journal of Surgery 58, no. 6 (June 1988): 495–97. http://dx.doi.org/10.1111/j.1445-2197.1988.tb06242.x.

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29

Di Bartolomeo, Roberto, Antonio Pantaleo, Paolo Berretta, Giacomo Murana, Sebastiano Castrovinci, Mariano Cefarelli, Gianluca Folesani, and Marco Di Eusanio. "Frozen elephant trunk surgery in acute aortic dissection." Journal of Thoracic and Cardiovascular Surgery 149, no. 2 (February 2015): S105—S109. http://dx.doi.org/10.1016/j.jtcvs.2014.07.098.

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30

Eldeiry, Mohamed, Muhammad Aftab, Joseph C. Cleveland, David A. Fullerton, and T. B. Reece. "Buffalo Trunk: Using Available Materials to Mimic the Benefits of a Hybrid Elephant Trunk Graft." Journal of the American College of Surgeons 227, no. 4 (October 2018): S41—S42. http://dx.doi.org/10.1016/j.jamcollsurg.2018.07.069.

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31

Li, Feng, Shu-feng Wang, Peng-cheng Li, Yun-hao Xue, Ji-yao Zou, and Wen-jun Li. "Restoration of active pick-up function in patients with total brachial plexus avulsion injuries." Journal of Hand Surgery (European Volume) 43, no. 3 (September 5, 2017): 269–74. http://dx.doi.org/10.1177/1753193417728405.

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We designed multiple nerve transfers in one surgery to restore active pick-up function in patients with total brachial plexus avulsion injuries. Forty patients with total brachial plexus avulsion injuries first underwent multiple nerve transfers. These included transfer of the accessory nerve onto the suprascapular nerve to recover shoulder abduction, contralateral C7 nerve onto the lower trunk via the modified prespinal route with direct coaptation to restore lower trunk function and onto the musculocutaneous nerve with interpositional bridging by medial antebrachial cutaneous nerve arising from lower trunk to restore elbow flexion, and the phrenic nerve onto the posterior division of lower trunk to recover elbow and finger extension. At least three years after surgery, the patients who had a meaningful recovery were selected to perform secondary reconstruction to restore active pick-up function. Active pick-up function was successfully restored in ten patients after they underwent multiple nerve transfers combined with additional secondary functional hand reconstructions. Level of evidence: IV
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Kshirsagar, AY, KS Shukla, YP Nikam, RB Garg, and TU Sholapurkar. "Bathing trunk nevus." Journal of Indian Association of Pediatric Surgeons 14, no. 2 (2009): 78. http://dx.doi.org/10.4103/0971-9261.55160.

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33

Kahraman, G., T. Marur, E. Tanyeli, and M. Yildirim. "Hepatomesenteric trunk." Surgical and Radiologic Anatomy 23, no. 6 (April 2002): 433–35. http://dx.doi.org/10.1007/s00276-001-0433-z.

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34

Kang, Ajaipal S., and Kevin S. Kang. "Rhomboid Flap for Large Cutaneous Trunk Defect." Plastic and Reconstructive Surgery - Global Open 8, no. 6 (June 2020): e2932. http://dx.doi.org/10.1097/gox.0000000000002932.

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35

Lawton, Michael T., Adib A. Abla, W. Caleb Rutledge, Arnau Benet, Zsolt Zador, Vitaliy L. Rayz, David Saloner, and Van V. Halbach. "Bypass Surgery for the Treatment of Dolichoectatic Basilar Trunk Aneurysms." Neurosurgery 79, no. 1 (December 14, 2015): 83–99. http://dx.doi.org/10.1227/neu.0000000000001175.

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Abstract BACKGROUND: The treatment of dolichoectatic basilar trunk aneurysms has been ineffectual or morbid due to nonsaccular morphology, deep location, and involvement of brainstem perforators. Treatment with bypass surgery has been advocated to eliminate malignant hemodynamics and to stabilize aneurysm growth. OBJECTIVE: To validate that flow alteration with bypass and parent artery occlusion favorably impacts aneurysm progression. METHODS: Surgical management evolved in 3 phases, each with different hemodynamic alterations. RESULTS: During a 17-year period, 37 patients with dolichoectatic basilar trunk aneurysms were retrospectively identified, of whom 21 patients were observed, 12 treated immediately, and 4 selected for treatment after clinical progression. In phase 1, flow reversal was overly thrombogenic, despite heparin (N = 5, final mortality, 100%). In phase 2, flow reduction with intracranial-to-intracranial bypass was safer than flow reversal, but did not prevent progressive aneurysm enlargement (N = 3, final mortality 67%). In phase 3, distal clip occlusion of the basilar trunk aneurysm preserved anterograde flow in the aneurysm without rupture, but reduced flow threatened perforator patency, despite treatment with clopidogrel (N = 8, final mortality 62%). CONCLUSION: Shifting treatment strategy for dolichoectatic basilar trunk aneurysms improved surgical (80% to 50%) and final mortalities (100% to 62%), with stabilization of aneurysms in the phase 3 survivors. Good outcomes are determined by perforator preservation and mitigating aneurysm thrombosis. Occlusion techniques with increased distal run-off seem to benefit perforators. The treatment of dolichoectatic basilar trunk aneurysms can advance through concentrated management in dedicated centers, concerted efforts to study morphology and hemodynamics with computational methods, and widespread collection of registry data.
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Rubayi, Salah, and Bala S. Chandrasekhar. "Trunk, Abdomen, and Pressure Sore Reconstruction." Plastic and Reconstructive Surgery 128, no. 3 (September 2011): 201e—215e. http://dx.doi.org/10.1097/prs.0b013e31822214c1.

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Koniaris, Leonidas G., and Juan E. Sola. "Prognostication for Trunk and Retroperitoneal Sarcomas." Annals of Surgery 252, no. 1 (July 2010): 201. http://dx.doi.org/10.1097/sla.0b013e3181e49000.

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Nathan, Hari, Timothy M. Pawlik, and Chandrajit P. Raut. "Prognostication for Trunk and Retroperitoneal Sarcomas." Annals of Surgery 252, no. 1 (July 2010): 201–2. http://dx.doi.org/10.1097/sla.0b013e3181e491b0.

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39

Kedar, Daniel J., Changsik John Pak, Hyunsuk Peter Suh, and Joon Pio Hong. "Propeller Flaps in the Posterior Trunk." Seminars in Plastic Surgery 34, no. 03 (August 2020): 176–83. http://dx.doi.org/10.1055/s-0040-1714086.

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AbstractThe reconstruction of complex posterior trunk defects remains challenging. But now with an increased knowledge of angiosomes and the practice of perforator flaps, the posterior trunk offers a new plethora of options for reconstruction. Propeller flaps based on such perforator(s) offer an elegant solution for managing defects while achieving primary donor-site closure without significant morbidity. We will discuss the relevant anatomy and design principles for propeller flaps based on a review of the literature and our experience. Steps beginning with preoperative planning, perforator selection, and intraoperative surgical technique will be discussed, together with pearls on both avoiding and managing complications.
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40

Ogawa, Rei. "Propeller Flaps for the Anterior Trunk." Seminars in Plastic Surgery 34, no. 03 (August 2020): 171–75. http://dx.doi.org/10.1055/s-0040-1714270.

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AbstractVarious types of propeller flaps from multiple donor sites can be used to reconstruct anterior trunk skin defects. The actual selection depends on the condition and location of the recipient site, especially if it is to be the chest or abdomen that requires attention. Before surgery commences, it is always important to use an imaging analyses such as computed tomography angiography to examine and identify perforators that could perfuse a perforator-pedicled propeller flap (PPPF), as it is the most multifaceted imaging technique. Clusters of perforators that can be commonly used for the “workhorse” PPPFs for the thoracic and abdominal regions are the internal mammary artery perforator, the musculophrenic artery perforator, and the deep inferior epigastric perforator. These perforators are reliable and large enough to support long and large propeller flaps that will cover most defects in this region, while still allowing primary donor-site closure.
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41

Boukoucha, Mabrouka, Abdelwahed Yahmadi, Hakim Znaidi, Raoudha Ben Khelifa, and Alifa Daghfous. "Spontaneous celiacomesenteric trunk dissection: Case report." International Journal of Surgery Case Reports 71 (2020): 128–31. http://dx.doi.org/10.1016/j.ijscr.2020.04.103.

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42

Hamdi, Moustapha, and Filip B. J. L. Stillaert. "Pedicled Perforator Flaps in the Trunk." Clinics in Plastic Surgery 37, no. 4 (October 2010): 655–65. http://dx.doi.org/10.1016/j.cps.2010.06.004.

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43

Reija, María Fe García, and Julia C. Blasco Palacio. "Bifid Facial Nerve Trunk." Journal of Craniofacial Surgery 27, no. 6 (September 2016): e541-e543. http://dx.doi.org/10.1097/scs.0000000000002858.

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44

Mammano, Enzo, Marco Cosci, Antonio Zanon, Gianfranco Picchi, Emanvela Tessari, Pierluigi Pilati, and Donato Nitti. "Celiomesenteric Trunk Aneurysm." Annals of Vascular Surgery 23, no. 2 (March 2009): 257.e7–257.e10. http://dx.doi.org/10.1016/j.avsg.2008.08.015.

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45

Rusu, Mugurel Constantin, and Bogdan Adrian Manta. "Pentafurcated Celiac Trunk." Annals of Vascular Surgery 70 (January 2021): 567.e1–567.e6. http://dx.doi.org/10.1016/j.avsg.2020.08.007.

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46

Kang, RyungA, Ji Seon Jeong, Ki Jinn Chin, Jae Chul Yoo, Jong Hwan Lee, Soo Joo Choi, Mi Sook Gwak, Tae Soo Hahm, and Justin Sangwook Ko. "Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery." Anesthesiology 131, no. 6 (December 1, 2019): 1316–26. http://dx.doi.org/10.1097/aln.0000000000002919.

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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Interscalene brachial plexus block of the C5–C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis. Injection around the superior trunk of the brachial plexus is an alternative technique that may reduce this risk. The authors hypothesized that the superior trunk block would provide noninferior postoperative analgesia compared with the interscalene block and reduce hemidiaphragmatic paresis. Methods Eighty patients undergoing arthroscopic shoulder surgery were randomized to receive a preoperative injection of 15 ml of 0.5% ropivacaine and 5 μg · ml−1 epinephrine around either (1) the C5–C6 nerve roots (interscalene block group) or (2) the superior trunk (superior trunk block group). The primary outcome was pain intensity 24 h after surgery measured on an 11-point numerical rating score; the prespecified noninferiority limit was 1. Diaphragmatic function was assessed using both ultrasonographic measurement of excursion and incentive spirometry by a blinded investigator before and 30 min after block completion. Results Seventy-eight patients completed the study. The pain score 24 h postoperatively (means ± SDs) was 1.4 ± 1.0 versus 1.2 ± 1.0 in the superior trunk block (n = 38) and interscalene block (n = 40) groups, respectively. The mean difference in pain scores was 0.1 (95% CI, −0.3 to 0.6), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit. Analgesic requirements and all other pain measurements were similar between groups. Hemidiaphragmatic paresis was observed in 97.5% of the interscalene block group versus 76.3% of the superior trunk block group (P = 0.006); paresis was complete in 72.5% versus 5.3% of the patients, respectively. The decrease in spirometry values from baseline was significantly greater in the interscalene block group. Conclusions The superior trunk block provided noninferior analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.
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47

Abdallah, Faraj W., Duminda N. Wijeysundera, Andreas Laupacis, Richard Brull, Aaron Mocon, Nasir Hussain, Kevin E. Thorpe, and Vincent W. S. Chan. "Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery." Anesthesiology 132, no. 4 (April 1, 2020): 839–53. http://dx.doi.org/10.1097/aln.0000000000003132.

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Abstract Background Interscalene brachial plexus block, the pain relief standard for shoulder surgery, is an invasive technique associated with important complications. The subomohyoid anterior suprascapular block is a potential alternative, but evidence of its comparative analgesic effect is sparse. The authors tested the hypothesis that anterior suprascapular block is noninferior to interscalene block for improving pain control after shoulder surgery. As a secondary objective, the authors evaluated the success of superior trunk (C5–C6 dermatomes) block with suprascapular block. Methods In this multicenter double-blind noninferiority randomized trial, 140 patients undergoing shoulder surgery were randomized to either interscalene or anterior suprascapular block with 15 ml of ropivacaine 0.5% and epinephrine. The primary outcome was area under the curve of postoperative visual analog scale pain scores during the first 24 h postoperatively. The 90% CI for the difference (interscalene-suprascapular) was compared against a –4.4-U noninferiority margin. Secondary outcomes included presence of superior trunk blockade, pain scores at individual time points, opioid consumption, time to first analgesic request, opioid-related side-effects, and quality of recovery. Results A total of 136 patients were included in the analysis. The mean difference (90% CI) in area under the curve of pain scores for the (interscalene-suprascapular) comparison was –0.3 U (–0.8 to 0.12), exceeding the noninferiority margin of –4.4 U and demonstrating noninferiority of suprascapular block. The risk ratio (95% CI) of combined superior trunk (C5–C6 dermatomes) blockade was 0.98 (0.92 to 1.01), excluding any meaningful difference in superior trunk block success rates between the two groups. When differences in other analgesic outcomes existed, they were not clinically important. Conclusions The suprascapular block was noninferior to interscalene block with respect to improvement of postoperative pain control, and also for blockade of the superior trunk. These findings suggest that the suprascapular block consistently blocks the superior trunk and qualify it as an effective interscalene block alternative. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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48

Fowkes, L. A., and S. G. Darke. "The morphology of the varicose short saphenous system." Phlebology: The Journal of Venous Disease 21, no. 2 (June 1, 2006): 55–59. http://dx.doi.org/10.1258/026835506777304737.

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Objective: Surgery for the varicose short saphenous vein (SSV) remains unsatisfactory. Specific problems include locating the saphenopopliteal junction (SPJ) and whether the trunk should be stripped. Recurrence rates are high. The objective was to review the morphology of varicose SSV and to address these aspects. Methods: Retrospective study of consecutive patients scheduled for SSV surgery based on initial continuous wave Doppler assessment. Detailed analysis of preoperative duplex ultrasound examinations with quantified reflux. Results: A total of 56 limbs (unilateral) were studied, male to female ratio was 18:38 and mean age was 51 years. SPJ: severe reflux in 47, mean diameter 8.1 mm (all above the skin crease [mean 2.7 cm]). Reflux was 'focal', being confined to the peri-junctional area with normal sized and competent distal short saphenous trunks in 29. In the remainder, incompetence was 'complete' with dilatation and reflux of the entire system. In only one limb did varicosities arise distally from a proximally competent system. Long saphenous vein ( LSV): coexistent reflux in 17, with communications with the SSV in 11. Deep reflux: at least one segment of deep reflux was found in 24 limbs. In this small study, no significant association with other morphology was found apart from 'complete' SSV reflux. Conclusion: The SPJ is usually severely incompetent, enlarged and sited above the skin crease. The morphology of the varicose SSV exhibits important differences from the LSV. In over half, incompetence is 'focal', confined to the peri-junctional vein and the distal trunk is competent suggesting a case for selective trunk stripping. Varicosities arising from a distally incompetent short saphenous trunk are uncommon.
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Borst, Hans G. "Modified Elephant Trunk Procedure." Journal of Cardiac Surgery 8, no. 4 (July 1993): 516. http://dx.doi.org/10.1111/j.1540-8191.1993.tb00402.x.

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50

Mosquera, Victor X., Carlos Velasco, Daniel Gulias, and Monica Mourelo Fariña. "Traumatic Brachiocephalic Trunk Pseudoaneurysm." Journal of Cardiac Surgery 28, no. 4 (May 9, 2013): 430–32. http://dx.doi.org/10.1111/jocs.12117.

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