Raynaud's Disease Surgery

It may be decided to treat Raynaud's disease with surgery if it is deemed necessary. Treatment with surgery; It is based on the elimination of the sympathetic chain, that is, the sympathetic nervous system activity that causes the finger veins to constrict, by entering through a small area on the inner side of the chest, called thoracic sympathectomy.

Symptoms of Reynaud's disease should not be neglected and it should be checked by a specialist physician to determine whether the disease is caused by a disease in the first place. Reynaud's disease, which is called primary and occurs on its own, can cause different diseases in the future if left untreated. Therefore, it is extremely important to determine appropriate treatment options by performing the necessary clinical examination, tests and analyzes in the treatment of this disease.

Surgery Duration
2-3 hours
Recovery Time
4-6 Months
Discharge Time
1-2 Days
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All About Raynaud's Disease

Prof. Dr. Yavuz Beşoğul

Raynaud's disease is a vascular disease that usually affects the fingers and toes, occurs as a result of reduced blood flow due to narrowing of the vessels, and can cause pain in the future. In some cases, it can also be seen in the ear or nose. It is a disease more common in young women. Situations in which Raynaud's disease occurs on its own are called primary Raynaud's, while cases accompanied by rheumatic diseases or other diseases are called secondary Raynaud's disease. Therefore, the most appropriate treatment method should be decided after the necessary analysis, tests and evaluations in the treatment of the disease.

Raynaud's Disease (Phenomenon)

It is a disease that is usually seen in young girls and rarely in boys and is accompanied by spasm (shrinkage and narrowing) of the small diameter arteries of the hand, which may improve with age. In emotional situations such as cold, stress, excitement, the hands become pale, blue, and cold, and in the future, excessive bruising, wound opening, and infection may occur on the fingertips. The reason is that stress causes excessive sympathetic activity and causes vasospasm (constriction) in the distal, small-diameter arteries of the hand. Delay in diagnosis causes this advanced condition. Diagnosis is usually made during examination; additionally, angiography or computed tomographic angiography may be helpful. The color change on the hands is evident with the hot and cold water test.

 

After Raynaud's Disease Diagnosis

Tanı konulduktan sonra tedavinin başında stresin azaltılması gelir ve hastanın takibi yapılır, şikayetlerin artması veya düzelmemesi durumunda, %98 oranında  iyileşme sağlayabilen sempatektomi ameliyatı yapılması en uygun tedavidir. Boyun ve göğüs bölgesine yapıldığı için servikal veya torakal sempatektomi ameliyatı olarak adlandırılır.

This surgery can be caused by cold, stress, etc. It is performed to eliminate the effect of sympathetic activity in that area, which is effective in certain situations and causes vasospasm (constriction) of the arteries.

By entering through a small incision in the armpit, the inner-back side of the chest is reached and the sympathetic chain is removed. There are no complications in experienced hands. However, the sympathetic chain must be completely removed, so the endoscopic and clip (staple) techniques used for sweating are not successful.

Within the first day and 1 month after the surgery, healing accelerates, hands become warmer, and normal color prevails.

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What Causes Raynaud's Disease?

The definitive diagnosis of Reynaud's disease is made by blood tests, finger blood pressure and blood flow measurements, as well as clinical examination.
Although the cause of Reynaud's disease is not fully known, it is considered that cold, stress, some drug use, the person's psychological state and cigarette consumption trigger the disease. As with the secondary Raynaud phenomenon, Reynaud's disease may occur due to some diseases such as rheumatological disease. Therefore, when Raynaud's symptoms are observed, it should be investigated whether there is an underlying disease.

Complaints of Raynaud's Patients

  • Color change in the form of paleness in the hands and fingers
  • Bruising of hands in cold weather
  • Cold hands, feeling cold
  • Increased bruising on the hands during changes between hot and cold
  • Occurrence of painful crises in the future

Raynaud's Disease Symptoms

  • Color change in the form of paleness in the hands and fingers
  • Bruising of hands in cold weather
  • Cold hands, feeling cold
  • Increased bruising on the hands during changes between hot and cold
  • Occurrence of painful crises in the future

Raynaud's Disease Symptoms Brief Information About

Raynaud's Disease Treatment

In the treatment of Raynaud's disease, the answer to the question of whether the disease is primary or secondary Raynaud's phenomenon must first be investigated. In Reynaud's phenomenon accompanied by other diseases such as rheumatic disease, the most appropriate treatment options should be determined after the necessary evaluations are made along with this disease.

In the treatment of Raynaud's disease, protection can be provided by taking protective measures against cold such as using hot water and using gloves in cold weather. The use of medication is one of the methods used in the treatment of Reynaud's disease. While Raynaud's disease can sometimes be cured with a very simple drug treatment, treatment for this disease that continues in the long term; It is based on the elimination of the sympathetic chain, that is, the sympathetic nervous system activity that causes the finger veins to constrict, by entering through a small area on the inner side of the chest, called thoracic sympathectomy. In this treatment, the patient becomes very comfortable and his past complaints disappear, and his hands even begin to overheat.

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Prof. Dr. Yavuz Beşoğul: Subaxillary Heart Surgery Description

The technique, popularly known as armpit heart surgery, is a heart operation performed through subaxillary or infra axillary minithoracotomy. Due to the complications of sternotomy, heart surgeries began to be performed with anterolateral thoracotomy in the world in the 1990s, and access incisions gradually became smaller. In 1997, we first started performing our surgeries by converting them to subaxillary incision in our country and contributed to the national and international literature in series. In fact, although there is no difference in the surgical technique, the entry technique has proven to be advantageous from bleeding to infection and early return to daily life. It reduces complications, especially in patients with diabetes, rib cage disorders, kidney failure and obesity. In addition, the small size of the incision and its location on the side are also important from a cosmetic perspective.

Advantages

On the other hand, the entrance site of the surgery provides excellent visibility and access, especially in terms of the exposure of the mitral, tricuspid and aortic valve. This is another factor that reduces complications. Since the rib spacing is different in terms of aortic and mitral valves, performing aortic and mitral valve, i.e. double valve, surgery may prolong the time and disrupt the chest structure and cause the ribs to break, which creates postoperative respiratory problems. Briefly; Aortic and mitral valve (double valve) surgery should not be performed with this technique. In such cases, a frontal incision, that is, ministernotomy, is more useful and there is no entry site complication.

SUBAXILLERY Surgery Technique

The patient is placed on the left side of the chest under double lumen intubation and general anesthesia; That is, an anterolateral thoracotomy position is given with the chest on the right side. A vertical 6 cm incision is made on the intersection of the subaxillary line and the right breast line. The pectoralis major and pectoralis minor muscles are dissected without cutting and a retractor is placed. The thorax is entered through the 3rd intercostal space for the aortic valve and the 4th intercostal space for the mitral valve, and right lung ventilation is provided. If it is turned off or not tolerated, the tidal volume is deducted. The pericardium opens and its leaves hang on the chest wall. Aorta, right and left atrium are clearly seen. After returning the aorta with the pedicle, it is suspended and the aorta, right auricle, and right atrium are easily cannulated. The patient is connected to the heart-lung pump, extra-corporeal circulation is transferred, ventilation is stopped and an x-clamp is placed on the aorta. Cardiac arrest is achieved by applying cold blood cardioplegia and topical cold saline. For the aortic valve, an incision is made at the aortic root and the aortic valve is clearly observed.

After Repair and Replacement

After axillary heart surgery repair or replacement is performed, the autotomy is closed. If the intervention is made through the 4th intercostal space, that is, for mitral valve surgery, the left atrium is opened and the image of the mitral valve is clear. After the repair or replacement is made, the left atrium is closed. The patient is warmed, the heart is defibrillated if necessary, and after starting, the pump flow is gradually reduced and stopped. The heart is easily decannulated. After bleeding control, a single chest drain is placed in the thorax (the location of the drain is important to avoid pain), the ribs are brought closer, and the muscles, subcutaneous and skin are closed properly. Postoperative follow-up is the same.

Although this intervention technique can be applied to every patient, it should not be preferred only in some cases. These :

Those with advanced lung problems
Those over 75 years of age,
Double valve replacement (Aortic and Mitral) required,
It should never be applied to patients requiring aortic valve surgery for the second time.
It is also an ideal method for second and third mitral valve surgeries and/or tricuspid valve surgeries.

Surgeries performed when the heart is arrested by connecting the heart to the lung pump are open heart surgeries. Surgeries performed while the heart is working and without connecting it to a heart-lung pump are closed heart or working heart surgery. However, among the public, surgeries that do not open from the front of the chest, that is, do not perform a sternotomy, are known as closed. In heart surgeries without sternotomy, various parts of the side walls of the chest may be preferred; The aim is to enter the chest and reach the heart through thoracotomy. The most useful of these techniques and the one that does not have any closure complications; It is a heart operation performed through subaxillary or infra-axillary minithoracotomy. Due to the complications of sternotomy, heart surgeries began to be performed with anterolateral thoracotomy in the world in the 1990s, and access incisions gradually became smaller.

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