Acute limb ischemia following perineal reconstruction in lithotomy position: take-home message for plastic surgeons

Despite the extensive use of lithotomy position in several plastic surgery procedures, most reports regarding the related incidence of complications are presented in the urologic, gynecologic, and anesthesiologic fields. We present the case of a 54-year-old male patient. polytrauma patient who underwent internal iliac artery embolization leading to extensive gluteal necrosis requiring: debridement, abdominoperineal resection and composite anterolateral thigh flap reconstruction with prolonged lithotomy position. The patient presented lower limb ischemia briefly after surgical theater. A computed tomography scan revealed the obstruction of the left superficial femoral artery requiring emergency revascularization. Arterial thrombosis is a potentially devastating complication and plastic surgeons should be aware of the possible dangers when performing surgeries in prolonged lithotomy position. Preoperative detection of patients at high risks for developing complications should be performed in order to implement preventive measures and avoid potentially life-threatening sequelae.

Effect of Internal Iliac Artery Embolization Combined With Arterial Infusion Chemotherapy On Serum VEGF, HGF and IL-6 in Advanced Cervical Cancer

This study aimed to investigate the effect of internal iliac artery embolization combined with arterial infusion chemotherapy on serum VEGF, HGF and IL-6 in advanced cervical cancer. A total of 120 cases of patients with advanced cervical cancer and admitted to Binzhou Center Hospital from January 2014 to March 2016 were selected as research subjects. Among them, 59 patients received arterial infusion chemotherapy were enrolled in the control group, and 61 patients received arterial infusion chemotherapy combined with internal iliac artery embolization were included in the observation group. Treatment efficacy, serum VEGF, HGF and IL-6 expression, KPS score and QOL score, incidence of adverse reactions and 3-year survival rate of the two groups were recorded and compared. The result showed that the therapeutic effect of the observation group was significantly higher than that of the control group (P<0.05). The expression of serum VEGF, HGF and IL-6, KPS score and QOL score in the two groups were significantly improved after treatment, with more significant improvement in the observation group (P<0.05). There were no significant differences in the incidence of adverse reactions between the two groups (P>0.05). And the 3-year survival rate of the observation group was significantly higher than that of the control group (P<0.05). In conclusion, arterial infusion chemotherapy combined with internal iliac artery embolization has a better effect than arterial infusion chemotherapy alone in treating patients with advanced cervical cancer. It can effectively prolong the survival of patients, along with good safety, which is worthy of clinical promotion

Letter to the Editor: Non-selective bilateral internal iliac artery embolization is a safe and effective way in hemorrhage control for hemodynamically unstable pelvic fractures

A recently published article by Lai et al. in BMC Musculoskeletal Disorders trying to show that patients with pelvic fractures undergoing non-selective internal iliac artery embolization may lead to a higher rate of surgical site infection. The authors also noted that only a small percentage of patients with contrast extravasation detected by emergency contrast-enhanced CT were subsequently confirmed by angiography, thus, considered that the value of enhanced CT in predicting arterial injury was limited. The authors also believe that embolization of the main stem may cause incomplete hemostasis due to the abundant collateral circulations in the pelvic cavity. Although the author’s findings are mentioned in other studies, the article’s data and pictures only partially supported its inferences, and the conclusions cannot be drawn directly. In this Correspondence, we tried to reinterpret the additional findings in the article from our perspective. Through this discussion, we hope that more colleagues can re-understand the safety and effectiveness of non-selective internal iliac artery embolization in treating hemodynamically unstable pelvic fractures during the early resuscitation stage.