[211115]
Gliatech recently rec'd a letter from a neurosurgeon concerning his experiences with adcon-l. In the letter he mentions one event that occurred out of 130 of his pts. The following is taken from the letter: "reporter has used adcon in 130 pts: 119 pts underwent surgery for a peripheral nerve problem and 11 underwent lumbar spine surgery. In these 130 pts, only 1 developed a problem attributable to the adcon: a sterile fluid accumulation following a surgical decompression of the radial nerve in the forearm. A reoperation was performed for drainage of the fluid which demonstrated no scarring at the site of surgery. A smooth capsule surrounding the fluid was resected and pathology demonstrated findings of a foreign body reaction: this pt was allergic to many substances. The pt improved clinically following these surgeries. " further info was obtained from the dr which detailed the incident. The pt underwent decompression and neurolysis of right radial nerve in the proximal forearm with intraoperative placement of adcon gel in 1999. The pt did well until 2 mos later when the pt noticed a soft painless lump at the surgical site. The lump has gradually increased in size. The pt has not experienced any change in strength or sensation in right upper extremity. The pt was admitted to the hosp and underwent both an ultrasound and mri which revealed a large fluid cavity in a complex cystic configuration, with perhaps a septation within it. The pt was admitted to the hosp and several cc's of cyst fluid were obtained through a needle aspiration. The fluid was found to be yellow and clear. A gram's stain was performed, which did not reveal any organisms. The pt was then started on iv kefzol prior to surgery. Description of procedure: pt rec'd an add'l gram of kefzol, just prior to the procedure. The old surgical site was prepped using betadine solution. After 25 cc of local anesthetic was injected in the old surgical incision (50%, 1% lidocaine with epineprhine + 50%m 1% marcaine diluted to a 1 to 10 ratio with sodium bicarbonate). The old incision was re-incised. "as they dissected through the subcutaneous tissue, they encountered capsular tissue, which was punctured. An add'l 10 cc of fluid was sent for diagnostic studies. The fluid appeared yellow and clear. " the wound was further opened by partially excising the capsular tissue. All the fluid drained out. The surrounding tissues appeared smooth and shiny and "there did not appear to be any significant adhesions". The wound was then inspected and excellent hemostatis was achieved. The wound was irrigated with copious amounts of normal saline containing bacitracin. The wound was then closed. The pt returned home and suffered a recurrent accumulation of fluid in a cystic configuration and had to have it drained periodically. The pt experienced increased soreness along right volar forearm. The pt also complains of shooting pains that extend proximally up to axilla and down to the fingers of right hand. In 1999 the pt went back the pt's original dr who stated "i could palpate a fullness over the pt's surgical site, but definite evidence of fluid. There was no erythema to suggest an on-going infection. The pt continues to demonstrate normal sensation in a distal right radial nerve distribution. I attempted to percutaneously aspirate fluid from the surgical region: however, i was unsuccessful. " the patient continued to suffer from painful symptoms, as well as fluctuating mass in right colar forearm. The pt was seen in the next month. Since the pt's last visit two weeks ago, the pt has noticed a reduction of pain in the pt's right forearm and improved function. The pt's physical exam continues to demonstrate 4 to 4+/5 strength in right radial nerve supplied muscles. The dr could not detect any fullness at the operative site. The pt underwent an ultrasound that day which did not reveal any evidence of underlying fluid. The dr concluded by saying: "i think patient is beginning to make a good recovery from the pt's surgery. Hopefully, the fluid will no longer reaccumulate. I have made plans to see the pt in two months time in order to continue monitoring the progress. "
Patient Sequence No: 1, Text Type: D, B5