ICVTS on-line discussion A
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《交互式心脏血管和胸部手术》
Mersin University School of Medicine, Department of Cardiovascular Surgery, Mersin 33079, Turkey
Neurological damage after radial artery harvesting in coronary surgery: a direct measure
eComment: The article by Reyes et al. [1] raises important concerns about the neurological injuries during radial artery harvesting. Harvesting technique is the most important point. Electrocautery is dangerous and most of the described lesions of the median nerve are due to electrocautery. The Harmonic scalpel (Ethicon) can be used in the harvesting as an alternative device. Several mechanisms are discussed as potential causes for subclinical nerve damage including sternal spreading, hematomas, edema and devascularization. CPB induces inflammatory response as another potential factor.
In this paper, the authors operated 10 patients on-pump and 5 patients offpump. First question is, how did the authors exclude these factors? In addition, it would have been highly interesting if the authors had also studied lower leg nerves on legs without vein harvesting in order to detect subclinical injury which may be caused by systemic rather than mechanical or vascular supply factors. Secondly, ideal neuroelectrophysiology study time is the 21st day after the operation so a study after 3 months following surgery is sufficient. On the other hand, early EMG studies are triggering false collateral innervations. In our recent study [2] which is similar to Reyes et al., we found that: Radial artery harvested patients were not affected by the surgery and also observed that the Median nerve is prone to impairment even it has no close relation to radial artery and the Ulnar nerve suffers mostly from sternotomy and retraction.
References
Reyes G, Traba A, Lopez L, Pinto A, Vallejo JL, Duarte J. Neurological damage after radial artery harvesting in coronary surgery: a direct measure. Interact CardioVasc Thorac Surg doi:10.1510/icvts.2005.116665.
Dogan OV, Duzgun C, Ozeren M, Alanoglu E, Dogan S, Simsek E, Yucel E. Subclinical injury to forearm nerves during radial harvesting: electrophysiologic study. J Card Surg 2006; 21:2151–154.
Related Article
Neurological damage after radial artery harvesting in coronary surgery: a direct measure
Guillermo Reyes, Alfredo Traba, Lidia López, ángel Pinto, Juan Duarte, and José Luis Vallejo
Interactive CardioVascular and Thoracic Surgery 2006 5: 433-438. [Full Text](Murat zeren)
Neurological damage after radial artery harvesting in coronary surgery: a direct measure
eComment: The article by Reyes et al. [1] raises important concerns about the neurological injuries during radial artery harvesting. Harvesting technique is the most important point. Electrocautery is dangerous and most of the described lesions of the median nerve are due to electrocautery. The Harmonic scalpel (Ethicon) can be used in the harvesting as an alternative device. Several mechanisms are discussed as potential causes for subclinical nerve damage including sternal spreading, hematomas, edema and devascularization. CPB induces inflammatory response as another potential factor.
In this paper, the authors operated 10 patients on-pump and 5 patients offpump. First question is, how did the authors exclude these factors? In addition, it would have been highly interesting if the authors had also studied lower leg nerves on legs without vein harvesting in order to detect subclinical injury which may be caused by systemic rather than mechanical or vascular supply factors. Secondly, ideal neuroelectrophysiology study time is the 21st day after the operation so a study after 3 months following surgery is sufficient. On the other hand, early EMG studies are triggering false collateral innervations. In our recent study [2] which is similar to Reyes et al., we found that: Radial artery harvested patients were not affected by the surgery and also observed that the Median nerve is prone to impairment even it has no close relation to radial artery and the Ulnar nerve suffers mostly from sternotomy and retraction.
References
Reyes G, Traba A, Lopez L, Pinto A, Vallejo JL, Duarte J. Neurological damage after radial artery harvesting in coronary surgery: a direct measure. Interact CardioVasc Thorac Surg doi:10.1510/icvts.2005.116665.
Dogan OV, Duzgun C, Ozeren M, Alanoglu E, Dogan S, Simsek E, Yucel E. Subclinical injury to forearm nerves during radial harvesting: electrophysiologic study. J Card Surg 2006; 21:2151–154.
Related Article
Neurological damage after radial artery harvesting in coronary surgery: a direct measure
Guillermo Reyes, Alfredo Traba, Lidia López, ángel Pinto, Juan Duarte, and José Luis Vallejo
Interactive CardioVascular and Thoracic Surgery 2006 5: 433-438. [Full Text](Murat zeren)