David M Brogan, Tony Y Lee, Yosita Beamer, Christopher J Dy
{"title":"止血带导致的神经缺血对尺侧神经移位患者手持神经刺激反应的影响","authors":"David M Brogan, Tony Y Lee, Yosita Beamer, Christopher J Dy","doi":"10.1097/PRS.0000000000011699","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Tourniquet-related nerve ischemia has been well studied in several reconstructive procedures, but the time course of impaired response to intraoperative stimulation is unclear. The present study evaluated ischemic effects on conduction during ulnar nerve transposition and examined the relationship between intraoperative and preoperative diagnostics. The authors hypothesized that intraoperative ischemia would have minimal impact on conduction.</p><p><strong>Methods: </strong>Thirty patients scheduled for anterior transposition were enrolled after preoperative examination, electrodiagnostic testing, and ultrasound. Demographic and symptom severity data were recorded. A handheld biphasic nerve stimulator was used intraoperatively to assess minimum amplitude and pulse duration needed for muscle response. Measurements were taken at 15-minute intervals after placement.</p><p><strong>Results: </strong>Changes in threshold amplitude and pulse duration were calculated between each 15-minute interval; no significant difference was found in the change of either value ( P = 0.70 and P = 0.178). A weak negative correlation existed between preoperative compound muscle action potential amplitudes and average intraoperative pulse duration, which increased to a moderate correlation when compared with 45-minute pulse duration ( r = -0.62; P < 0.01). Preoperative ulnar nerve cross-sectional area demonstrated no significant correlation with average pulse duration but a moderate correlation with pulse duration at 45 minutes ( r = 0.63; P = 0.01).</p><p><strong>Conclusions: </strong>Tourniquet use did not prevent effective intraoperative stimulation of the ulnar nerve for at least 45 minutes. The window for meaningful stimulation with tourniquet use appears to be greater than previously thought. Preoperative nerve compound muscle action potential amplitude and cross-sectional area does appear to influence pulse duration required after 45 minutes of ischemia, suggesting that injured nerves are more susceptible to ischemia.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"505-512"},"PeriodicalIF":3.2000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of Tourniquet-Related Nerve Ischemia on Response to Handheld Nerve Stimulation in Ulnar Nerve Transposition.\",\"authors\":\"David M Brogan, Tony Y Lee, Yosita Beamer, Christopher J Dy\",\"doi\":\"10.1097/PRS.0000000000011699\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Tourniquet-related nerve ischemia has been well studied in several reconstructive procedures, but the time course of impaired response to intraoperative stimulation is unclear. The present study evaluated ischemic effects on conduction during ulnar nerve transposition and examined the relationship between intraoperative and preoperative diagnostics. The authors hypothesized that intraoperative ischemia would have minimal impact on conduction.</p><p><strong>Methods: </strong>Thirty patients scheduled for anterior transposition were enrolled after preoperative examination, electrodiagnostic testing, and ultrasound. Demographic and symptom severity data were recorded. A handheld biphasic nerve stimulator was used intraoperatively to assess minimum amplitude and pulse duration needed for muscle response. Measurements were taken at 15-minute intervals after placement.</p><p><strong>Results: </strong>Changes in threshold amplitude and pulse duration were calculated between each 15-minute interval; no significant difference was found in the change of either value ( P = 0.70 and P = 0.178). A weak negative correlation existed between preoperative compound muscle action potential amplitudes and average intraoperative pulse duration, which increased to a moderate correlation when compared with 45-minute pulse duration ( r = -0.62; P < 0.01). Preoperative ulnar nerve cross-sectional area demonstrated no significant correlation with average pulse duration but a moderate correlation with pulse duration at 45 minutes ( r = 0.63; P = 0.01).</p><p><strong>Conclusions: </strong>Tourniquet use did not prevent effective intraoperative stimulation of the ulnar nerve for at least 45 minutes. The window for meaningful stimulation with tourniquet use appears to be greater than previously thought. Preoperative nerve compound muscle action potential amplitude and cross-sectional area does appear to influence pulse duration required after 45 minutes of ischemia, suggesting that injured nerves are more susceptible to ischemia.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>\",\"PeriodicalId\":20128,\"journal\":{\"name\":\"Plastic and reconstructive surgery\",\"volume\":\" \",\"pages\":\"505-512\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Plastic and reconstructive surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PRS.0000000000011699\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Plastic and reconstructive surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PRS.0000000000011699","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Effect of Tourniquet-Related Nerve Ischemia on Response to Handheld Nerve Stimulation in Ulnar Nerve Transposition.
Background: Tourniquet-related nerve ischemia has been well studied in several reconstructive procedures, but the time course of impaired response to intraoperative stimulation is unclear. The present study evaluated ischemic effects on conduction during ulnar nerve transposition and examined the relationship between intraoperative and preoperative diagnostics. The authors hypothesized that intraoperative ischemia would have minimal impact on conduction.
Methods: Thirty patients scheduled for anterior transposition were enrolled after preoperative examination, electrodiagnostic testing, and ultrasound. Demographic and symptom severity data were recorded. A handheld biphasic nerve stimulator was used intraoperatively to assess minimum amplitude and pulse duration needed for muscle response. Measurements were taken at 15-minute intervals after placement.
Results: Changes in threshold amplitude and pulse duration were calculated between each 15-minute interval; no significant difference was found in the change of either value ( P = 0.70 and P = 0.178). A weak negative correlation existed between preoperative compound muscle action potential amplitudes and average intraoperative pulse duration, which increased to a moderate correlation when compared with 45-minute pulse duration ( r = -0.62; P < 0.01). Preoperative ulnar nerve cross-sectional area demonstrated no significant correlation with average pulse duration but a moderate correlation with pulse duration at 45 minutes ( r = 0.63; P = 0.01).
Conclusions: Tourniquet use did not prevent effective intraoperative stimulation of the ulnar nerve for at least 45 minutes. The window for meaningful stimulation with tourniquet use appears to be greater than previously thought. Preoperative nerve compound muscle action potential amplitude and cross-sectional area does appear to influence pulse duration required after 45 minutes of ischemia, suggesting that injured nerves are more susceptible to ischemia.
Clinical question/level of evidence: Therapeutic, IV.
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For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis.
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