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Here is a video that shows the harvest of a thin profunda artery perforator flap from the left thigh. In conjunction with preoperative computed tomography angiography, measurement of the morphology of the perforators and their branches, the pedicle length, and the vertical locations of the two branches from the ischial tuberosity are performed. A handheld doppler is used to confirm the location of both branches. As a result of the authors' results, preoperative computed tomography angiography is a valuable way of obtaining detailed anatomical information such as the shape of perforators, their path through the septum or muscle above the deep fascia, as well as the thickness of the skin. It is important to know that computed tomographic angiography is an excellent means of making an assessment of the entire vascular anatomy of the leg, and it results in making an informed decision about the choice of flaps, based on the patient's anatomy and the characteristics of the defect.
Vertical sleeve gastrectomy (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 the authors report herein a modified technique with 2 disposable micro-clamps to simplify the surgery. The key aspects of the modification are to use the micro-clamps as non-crushing tissue clamps for anastomosis as well as vascular clamps for hemostasis. Mean body weight at postoperative week 1 was 24.1 grams, which is equivalent to a 16.1% loss of original body weight, and there was no mortality after antrum preservation VSG. This simplified surgical technique will best serve as a tool to investigate either the underlying mechanisms of VSG or the intrinsic change to the stomach after VSG.
One of the aims of several reconstructive surgical procedures is to achieve a patent microvascular anastomosis. Developing clinical competency in this specialized skill requires intensive training on live animal models as a first step. The early training stage of microvascular anastomosis can be stressful for novices. This is because the rat vessels used in such training courses are usually too small and fragile for novices to maintain the vascular lumen in an optimal fashion. Throughout this paper, the authors discuss the use of a silicone tube to provide structural support to vessels throughout the entire precarious suturing process. Using this modified version of the conventional microvascular anastomosis technique may facilitate initial skill acquisition in the rat model.
Lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer (VLNT) are established lymphedema treatments. However, LVA is only effective for early disease and VLNT can cause donor-site lymphedema and contour deformity. Vascularized lymph vessel transfer (VLVT) is free of these limitations. In the video, the authors described their experience of a new VLVT technique.
This video shows a laryngoscopic examination for signs of laryngeal irritation associated with laryngopharyngeal reflux. Large bilateral granulomas are identified on the surface of bilateral arytenoids
This is a video abstract regarding the article on the role of trapezius transfer for shoulder reconstruction in adult traumatic brachial plexus injuries.
Over the past decade, Da Vinci Surgical System has made great strides in surgery. It has been widely applied in urology, gynecology, bariatric surgery, hepatobiliary surgery, thoracoscopic surgery, cardiac surgery, neurological surgery, and transoral otolaryngologic neoplasm resection. However, its application in plastic and reconstructive surgery still in the preliminary stages of development. I went to Hong Kong in April 2013 for the robotic surgical system training program and was awarded console surgeon certificate.
This novel technique of sequential ETS micro-venous anastomosis is a modified technique from its classical form. The unique use of vessel loops provides protection to the vessel, while it achieves equisegmental IJV occlusion for sequential (proximal to distal) venous anastomosis. This method not only saves precious operating time from repetitive positioning of instruments and recipient vessel (IJV), but also creates a safer operating field for the microsurgeons. Utilizing a second single vascular clamp over the anastomosis junction provides an anchoring point for self-retraction by revealing and maintaining an accessible position to the posterior wall, once it is turned at 180 degrees laterally. This maneuver allows the surgeon to have full control of the surgical field and perform ETS micro-venous anastomosis confidently and independently.
Division of the lateral plantar artery does not jeopardize the foot circulation because of anastomosis of the lateral plantar artery with the dorsalis pedis artery at the first intermetatarsal space. However, care should be taken with patients with peripheral artery occlusive disease and the flow of dorsalis pedis artery should be confirmed before surgery. Given the advantages of sizable vessel, easy dissection, and proximity to the defect, we believe that the lateral plantar artery might be a valuable option as recipient vessel for lateral plantar forefoot reconstruction.
Pedicled anterolateral thigh flap is a versatile option for reconstruction of complex soft tissue defects in varied anatomical regions. Its wide arc of rotation and less donor site morbidity are its added advantages.
The 2nd instructional course for adult brachial plexus injuries is a fantastic opportunity to meet and learn from experts in the field. We cordially invite you to visit Chang Gung Memorial Hospital to participate in this unique learning experience.