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World Journal of Surgery

, Volume 39, Issue 8, pp 1936–1942 | Cite as

Parathyroid Reimplantation in Forearm Subcutaneous Tissue During Thyroidectomy: A Simple and Effective Way to Avoid Hypoparathyroidism

  • Giuseppe CavallaroEmail author
  • Olga Iorio
  • Marco Centanni
  • Natale Porta
  • Angelo Iossa
  • Lucilla Gargano
  • Susanna Del Duca
  • Angela Gurrado
  • Mario Testini
  • Vincenzo Petrozza
  • Gianfranco Silecchia
Original Scientific Report

Abstract

Introduction

Parathyroid autotransplantation plays an important role in preventing hypoparathyroidism following thyroidectomy. The preferred reimplantation site is still the sternocleidomastoid muscle, but this approach does not permit to check graft vitality postoperatively. The authors report the first prospective evaluation of normal parathyroid gland reimplantation in forearm subcutaneous tissue (using the same technique proposed during parathyroidectomy for hyperplasia) in case of devascularized or inadvertently removed glands during thyroid surgery.

Materials and methods

From January 2013 to August 2014, we performed 348 consecutive thyroidectomies for various disease, both benign and malignant. In 25 cases, due to inadvertent parathyroid removal or evidence of insufficient blood supply, we removed and fragmented the gland into 0.5–1 mm slices (one for frozen section) and reimplanted it into two subcutaneous pockets on the non-dominant forearm. After surgery we checked grafted gland function by evaluation of serum parathormone gradient between reimplanted versus non-reimplanted arm (considering significant a ratio of 1.5 or more), at 1 week, 1 and 3 months after surgery.

Results

We observed recovery of reimplanted graft function in 48, 88 and 96 % of patients respectively at 1 week, 1 and 3 months after surgery. All patients showed normal parathormone levels in peripheral blood (non-reimplanted arm). In one case we observed post-operative wound hematoma on graft-site. This patient showed no graft functionality in post-operative period (even at 3 months follow-up).

Conclusions

Parathyroid gland reimplantation in forearm subcutaneous tissue during thyroid surgery is a safe, easy and effective procedure; furthermore, it allows a good control of graft functionality and would allow an easy grafted gland removal if needed.

Keywords

Parathyroid Gland Hypoparathyroidism Sternocleidomastoid Muscle Parathyroid Tissue Parathyroid Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Giuseppe Cavallaro
    • 1
    Email author
  • Olga Iorio
    • 1
  • Marco Centanni
    • 1
  • Natale Porta
    • 1
  • Angelo Iossa
    • 1
  • Lucilla Gargano
    • 1
  • Susanna Del Duca
    • 1
  • Angela Gurrado
    • 2
  • Mario Testini
    • 2
  • Vincenzo Petrozza
    • 1
  • Gianfranco Silecchia
    • 1
  1. 1.Department of Medico-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
  2. 2.Department of Biomedical Sciences and Human OncologyUniversity of BariBariItaly

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