Microsurgery
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Although direct exposure to procedures in the operating theater environment, together with practice on laboratory animals, is still seen as the gold standard of teaching in microsurgery, practice on nonliving simulators is currently being validated as an important educational tool. We reviewed the widely used nonliving training models, together with currently accepted innovations, which are parts of curricula of training courses in microsurgery. Using the experience accumulated in training programs at the Centre for Simulation and Training in Surgery, we identified which particular skills can be reliably targeted by each nonliving tissue exercise. ⋯ The training program can comprise a series of increasingly difficult exercises, which mirror the real life situations. Performance on nonliving models in each progressively more challenging exercise can be assessed via direct observation, assisted by clear and objective criteria. Finally, focused training will help both the transition to human surgery and replication of the favorable results to large series of subjects.
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Preoperative imaging is sought prior to DIEA (Deep Inferior Epigastric Artery) perforator flaps due to the potential for maximizing operative success and minimizing operative complications. Recent advances include the use of computed tomography (CT) angiography (CTA) and magnetic resonance angiography. Image-guided stereotactic surgery is a recent technique that has been used with success in several fields of surgery. ⋯ Stereotactic navigation demonstrated a slightly better (nonsignificant) correlation with perforator location than conventional CTA. As such, CT-guided stereotactic imaging is an accurate method for the preoperative planning of DIEA perforator flaps, providing additional and potentially more accurate data to conventional CTA. With no additional scanning required, the method described in this paper allows the combined use of both methods for preoperative planning.
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The incidence of obstetric brachial plexus palsy is not declining. Heavy birth weight of the infant and breech delivery are considered two important risk factors and Caesarean section delivery seems to be a protective factor. ⋯ Surgical intervention is needed for 20-25% of all patients and clinical information is decisive for the indication of surgery. Most often, a conducting neuroma of the upper trunk is encountered, and it is believed that neuroma resection followed by microsurgical reconstruction of the brachial plexus gives the best results.
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Case Reports
Synchronous reconstruction of the floor of mouth and chin with a single skin island fibular free flap.
The goal this presentation is to: 1) Review the reconstructive options for anterior mandible through-and-through composite defects and 2) Instruct the audience in the application of the double-skin paddle fibular flap in selected patients. ⋯ Several reconstructive options have been described in the literature for extended oral cavity defects including the use of multiple free flaps, combinations of regional and distant flaps, and sequential reconstruction. This case report reviews the use of a single flap reconstruction of these defects for selected patients.
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The purpose of the paper is to review the results of free latissimus dorsi transfer for scalp and cranium reconstruction in case of large defects with exposed brain tissue, deperiosted cranial bone, and dura that cannot be reconstructed with local flaps or skin grafts. ⋯ Besides the free omentum flap, the free latissimus dorsi transfer is the only option for coverage of subtotal or total scalp defects. Compared to the omentum flap, the latissimus dorsi offers more tissue, has less donor site morbidity, and secondary surgery such as cranial bone reconstruction is possible. Contrary to most authors, our preferred donor vessels are maxillary artery and the external jugular vein. To avoid any vascular compression we are using a myo-cutaneous flap. The skin island must be removed secondarily. In patients were no bone reconstruction is possible or planned, the deepithelialized skin paddle can be used for correction of a contour defect.