Use of a Javid™ shunt in the management of axillary artery injury as a complication of fracture of the surgical neck of the humerus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Axillary artery injury is a rare but severe complication of fractures of the surgical neck of the humerus.</p> <p>Case presentation</p> <p>We present a case of axillary artery pseudoaneurysm secondary to such a fracture, in a 82-year-old white woman, presenting 10 weeks after the initial injury, successfully treated with subclavian to brachial reversed vein bypass together with simultaneous open reduction and internal fixation of the fracture. We discuss the use of a Javid™ shunt during combined upper limb revascularisation and open reduction and internal fixation of the fractured humerus.</p> <p>Conclusion</p> <p>This case highlights the usefulness of a Javid™ shunt, over other forms of vascular shunts, in prompt restoration of blood flow to effect limb salvage. It can be considered as a temporary measure whilst awaiting definitive revascularisation which can be performed following fracture fixation.</p

Are Brain Natriuretic Peptide Levels Related to Flow through Autologous Aterio-Venous Fistulae for Chronic Haemodialysis?

Formation of arterio-venous-fistulae (AVF) may exacerbate cardiac failure in the ever increasing, elderly population on haemodialysis. Brain Natriuretic Peptide (BNP) may prove a useful marker of cardiac failure in this population. We aimed to determine effect of creation of an AVF and flow in AVF on BNP levels. Ten patients undergoing primary formation of an upper limb autologous AVF (pre-dialysis), were recruited. Serum BNP (pg/ml) and flow in AVF (cm3/s) were documented pre-operatively, and then 2, 6 and 12 weeks post-operatively. The relationship between flow and BNP levels was assessed. Ten patients (6 male), mean age of 66yrs were recruited. Five patients had a radio-cephalic and 5 had a brachio-cephalic AVF formed. There was no correlation between BNP levels and flow within the AVF (r=0.34, p=0.28) at any time point. There was a general trend towards increased flow in the AVF over time, with only the change between flow at 2-weeks and 3-months postoperatively reaching significance, p=0.043. There was a general trend for BNP to fall over time in the postoperative period, with no significant change between the postoperative sampling time points. BNP levels do not correlate with flow across an AVF

Use of early scanning in fistula formation for vascular access

Purpose To determine the feasibility and role of early scanning in the assessment of arteriovenous fistulae fashioned for vascular access. Methods Retrospective case note analysis of 98 patients who underwent early scanning (between 7 and 28 days) of their fistula as well as routine scanning at 6 weeks over a 2–year period. Results The median time was 16 days to the first scan and 51 days to the second scan. Only 1 fistula was unable to be assessed at the first scan. There were 73 normal first scans, 11 of these had an abnormal second scan showing 4 occlusions, 4 stenoses, and 3 with low flow. There were 25 abnormal first scans. Five were occluded with a mean time to scan of 16.7 days. Eleven of the 25 had a narrow vein. By the second scan, 6 had matured, 3 had occluded, and 2 had failed to mature. Nine of the 25 had low flow, elevated velocities, or a stenosis. By the second scan, 2 had matured, 4 had occluded, and 3 had failed to mature. Conclusions Our results show that early scanning in the surveillance of arteriovenous fistula formation for vascular access is both feasible and reveals a significant number of abnormalities. Early scanning does not remove the need for the routine 6–week scan. </jats:sec

The analgesic effect of odour and music upon dressing change

Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side-effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain

The analgesic effect of odour and music upon dressing change

Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side-effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain

Exploring the analgesic effect of two complementary therapies during vascular dressing change

Alison Coull – ORCID: 0000-0002-3166-0699 https://orcid.org/0000-0002-3166-0699Item not available in this repository.https://www.wounds-uk.com/eventspubpu