Vascular Reconstructions: Anatomy, Exposures and Techniques by Jamal J. Hoballah

By Jamal J. Hoballah

This must-have guide for surgical citizens and vascular surgical procedure trainees is copiously illustrated with greater than 250 unique line drawings. the writer offers in a step by step type the options for all universal vascular reconstructions, fundamentals of publicity and entry, in addition to precious technical pearls and suggestions. The textual content presents the surgical trainee with the chance to study and perform the mandatory vascular reconstructions ahead of getting into the working room. The illustrations and transparent directions make this a guide that's observed time and again through the surgical residency.

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Sample text

The phrenic nerve is identified as it lies anterior to the anterior scalene muscle crossing from its lateral to medial side. The scalenus anterior muscle is divided close to its insertion onto the first rib while retracting and protectLt Vertebral artery Lt Subclavian artery Lt Thyrocervical trunk ing the phrenic nerve. 8 A supraclavicular incision is ideal for exposure of the second part and distal segincision are ligated to avoid the com- ment of the first part of the subclavian artery. It also allows for exposure of the proximal segment of the vertebral artery.

The polyester yarn is then woven or knitted to produce the graft fabric. Textile grafts are porous. Healing and tissue ingrowth into textile grafts tend to increase with the porosity of the fabric. However, bleeding through the interstices of the grafts will also increase with the porosity of the graft. Textile grafts are usually crimped to provide some degree of elasticity and support across curvatures or joints. However, the elasticity is usually lost after the graft is implanted. In woven polyester grafts, straight yarns are interlaced in an over-and-under pattern.

Vascular Anatomy and Exposures 33 Details of the Supraclavicular Exposure of the Subclavian Artery A supraclavicular incision is made starting 1–2 cm above the clavicle between Transected anterior scalene muscle the heads of the sternocleidomastoid Phrenic nerve muscle. The incision extends laterally and parallel to the clavicle for 10–12 cm and is deepened through the subcutaneous tissues to expose the platysma muscle (Fig. 8). The platysma muscle is divided with electrocautery to expose the scalene fat pad.

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