The authors report the first published case of a patient presenting with stridor from an acute, near complete, airway obstruction with normal biochemical markers, as the initial presentation of a parathyroid adenoma, which required immediate surgical intervention. The learning point from this case is to ensure a broad differential is placed forward when dealing with acute neck swelling. Routine Head and Neck pathology can present in an unusual fashion, with resultant challenging presentations.

A thin profunda artery perforator flap harvested from the left thigh is shown in this video. Preoperative computed tomographic angiography is used to assess morphology of the perforators and its branches, pedicle length and vertical location of the two branches from the ischial tuberosity. These measurements are translated on to the patient. Locations of both branches are confirmed with a handheld doppler. The authors concluded that preoperative computed tomographic angiography is a useful technique to provide detailed anatomic information on morphology of perforators, course through the septum or muscle above the deep fascia and skin thickness. Computed tomographic angiography allows quick and easy assessment of the whole vascular anatomy of the leg and helps to arrive at the decision about selection of the best flaps based on the characteristics of the defect and on the individual anatomy of the patient.

The supraclavicular flap has gained popularity in recent years as a reliable and easily harvested flap with occasional anatomical variations in the course of the pedicle. The study shows how the determination of the dominant pedicle may be aided with indocyanine green angiography. Additionally, the authors demonstrate how they convert a supraclavicular flap to a free flap if the dominant pedicle is unfavorable to a pedicled flap design.

The study assesses the correlation between lipid-laden macrophage index in tracheal secretions (tLLMI) acquired at the time of direct laryngobronchoscopy (DLB) with the bronchoalveolar LLMI (aLLMI) collected via flexible bronchoscopy. Assessment of lipid-laden macrophages within bronchoalveolar lavage fluid has been proposed to be diagnostically helpful in evaluation of tracheobronchial inflammation. However, measurement requires flexible bronchoscopy with bronchoalveolar lavage, which can be associated with oxygen desaturation and post-operative fever. Quantification of lipid-laden macrophages in tracheal material has not been explored. The study demonstrates that the LLMI in tracheal aspirates collected at the time of DLB correlates with that of aspirates measured directly from the lower airways.

The implications of rebound heparin hypercoagulability following cessation of therapy in microsurgery is unreported. In this article the authors report two cases of late digit circulatory compromise shortly after withdrawal of heparin therapy. The authors also propose potential consideration for changes in perioperative anticoagulation practice to reduce this risk.

ICG lymphography is an invaluable tool in lymphedema management. Both immediate and delayed scans are needed when performing the study. The delayed scan needs to be performed at the time of the lymphographic plateau to appreciate the full extent of the pathology. Using a recumbent cross trainer, the lymphographic plateau can be achieved in 15 minutes following ICG injection. We have found this exercise enhanced ICG lymphography protocol worthwhile of adoption by high volume lymphedema centers to raise diagnostic accuracy and efficiency.

This case report describes authors successfully attempt to perform a topographically correct sural nerve transplantation in the extracranial facial nerve stem using the intraneural facial nerve stem topography proposed by Meissl in 1979. This is the first reported case of successful fascicular nerve grafting of the facial nerve stem following extensive laceration.

This article presented 3 cases diagnosed with chronic fatigue syndrome, severe skin adjuvant infiltration and skin ulcers.

VSG is a type of bariatric surgery that is accepted as the simplest but most efficient surgical modality to treat morbid obesity. A mouse model of VSG has been widely utilized to investigate the underlying mechanisms of VSG. There are numerous microsurgical techniques for VSG in mice, and we report herein a modified technique with 2 disposable micro-clamps to simplify the surgery.

Ectopic hamartomatous thymoma is a rare neoplasm with classic anatomical location and characteristic histological and immunohistochemical features. Awareness of ectopic hamartomatous thymoma is essential to accurately diagnose these lesions which clinically mimics lipoma. Based on the morphologic and immunophenotypic features, the authors stress the need to discontinue the existing term of ectopic hamartomatous thymoma and replacing it with suitable nomenclature that aptly denotes its phenotype and possible histogenesis. The authors propose a new terminology “Triphasic Epithelial Myoepithelial Mesenchymal Branchial Anlage Tumor (TEMM-BAT)” as it encompasses three important constituents of the lesion (epithelial, myoepithelial, and mesenchymal) and its possible histogenesis in relation to branchial remnants.