title: Parathyroid Reimplantation in Forearm Subcutaneous Tissue During Thyroidectomy: A Simple and Effective Way to Avoid Hypoparathyroidism.
abstract: BACKGROUND
  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.
  
  
  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.
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, LT, Italy, giuseppe.cavallaro@uniroma1.it.
authors: Giuseppe
authors: G
authors: Cavallaro
authors: Olga
authors: O
authors: Iorio
authors: Marco
authors: M
authors: Centanni
authors: Natale
authors: N
authors: Porta
authors: Angelo
authors: A
authors: Iossa
authors: Lucilla
authors: L
authors: Gargano
authors: Susanna
authors: S
authors: Del Duca
authors: Angela
authors: A
authors: Gurrado
authors: Mario
authors: M
authors: Testini
authors: Vincenzo
authors: V
authors: Petrozza
authors: Gianfranco
authors: G
authors: Silecchia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005542:Forearm / Q000601:surgery; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000502:physiology / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies; D040521:Subcutaneous Tissue / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone