EP.TU.40Tendon Repair Training: An Alternative Approach

Abstract Aims The COVID-19 pandemic has seen reduced training opportunities for surgical trainees. Tendon repair is an important surgical skill for all core surgical trainees. It is particularly essential for those training within Plastic and Orthopaedic surgery. Tendon repair simulation often involves the use of expensive materials or animal tissues, posing ethical predicament. Here we aimed to devise a simple and reproducible method for tendon repair simulation. Methods Our tendon simulation model is an inexpensive and easily set up arrangement consisting of edible strawberry laces. Results The tendon simulator gives reasonable replication of a tendon, with the laces depicting an inner and outer core of a severed tendon. In addition the materials are easy to acquire, handle, dispose of and are free from ethical limitations. Conclusions Surgical trainees will be able to practice varying tendon repair techniques on this model, applying basic surgical principles such as instrument and tissue handling and develop their expertise.

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Does error feedback improve the learning of a simple surgical skill?

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363514x13990346756364 ◽

2014 ◽

Vol 96 (8) ◽

pp. e1-e4

Author(s):

S Nagala ◽

R Brar ◽

GA Phillips ◽

C Van Wyk ◽

M Lee

Keyword(s):

Detrimental Effect ◽

Surgical Skills ◽

Working Time ◽

Error Feedback ◽

Surgical Skill ◽

Knot Tying ◽

Surgical Trainees ◽

European Working ◽

The Uk ◽

Training Opportunities

The European Working Time regulations (EWTr) have led to a decrease in training opportunities for surgical trainees in the uk. it is therefore imperative that effciency of training is optimised to enable trainees to attain procedural competence within their curtailed training period. Workplace-based assessments are central to the intercollegiate Surgical curriculum Programme. These tools are important as not only do they give a formal way of assessing the trainee but they also trigger formal feedback of performance. The importance of feedback in learning surgical skills has been highlighted for procedures ranging from simple subcuticular suturing 1 and knot tying 2 to more complex vascular anastomoses 3 and laparoscopic work. 4 lack of feedback has been shown previously to have a detrimental effect on learning. 5

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Chemical and Biological Molecules Involved in Differentiation, Maturation, and Survival of Dopaminergic Neurons in Health and Parkinson’s Disease: Physiological Aspects and Clinical Implications

Biomedicines ◽

10.3390/biomedicines9070754 ◽

2021 ◽

Vol 9 (7) ◽

pp. 754

Author(s):

Giulia Gaggi ◽

Andrea Di Credico ◽

Pascal Izzicupo ◽

Giovanni Iannetti ◽

Angela Di Baldassarre ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dopaminergic Neurons ◽

Potential Role ◽

High Efficiency ◽

Biological Molecules ◽

Alternative Approach ◽

Non Coding Rnas ◽

Set Up

Parkinson’s disease (PD) is one of the most common neurodegenerative disease characterized by a specific and progressive loss of dopaminergic (DA) neurons and dopamine, causing motor dysfunctions and impaired movements. Unfortunately, available therapies can partially treat the motor symptoms, but they have no effect on non-motor features. In addition, the therapeutic effect reduces gradually, and the prolonged use of drugs leads to a significative increase in the number of adverse events. For these reasons, an alternative approach that allows the replacement or the improved survival of DA neurons is very appealing for the treatment of PD patients and recently the first human clinical trials for DA neurons replacement have been set up. Here, we review the role of chemical and biological molecules that are involved in the development, survival and differentiation of DA neurons. In particular, we review the chemical small molecules used to differentiate different type of stem cells into DA neurons with high efficiency; the role of microRNAs and long non-coding RNAs both in DA neurons development/survival as far as in the pathogenesis of PD; and, finally, we dissect the potential role of exosomes carrying biological molecules as treatment of PD.

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The search for the ideal tendon repair in zone 2: strand number, anchor points and suture thickness

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413508699 ◽

2013 ◽

Vol 39 (1) ◽

pp. 20-29 ◽

Cited By ~ 32

Author(s):

R. Savage

Keyword(s):

Animal Model ◽

Laboratory Tests ◽

Tendon Repair ◽

Clinical Results ◽

Review Article ◽

Cyclic Motion ◽

Mechanical Factors ◽

Anchor Points ◽

Repair Techniques ◽

The Ideal

This review article examines the mechanical factors involved in tendon repair by sutures. The repair strength, repair stiffness and gap resistance can be increased by increasing the number of core strands and anchor points, by increased anchor point efficiency and the use of peripheral sutures, and by using thicker sutures. In the future, laboratory tests could be standardized to a specific animal model and to a defined cyclic motion programme. Clinical studies support the use of multi-strand core and peripheral sutures, but two-strand core sutures are not adequate to ensure consistently good clinical results. Training surgeons in complex tendon repair techniques is essential.

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Looped suture properties: implications for multistranded flexor tendon repair

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413516245 ◽

2015 ◽

Vol 40 (3) ◽

pp. 234-238 ◽

Cited By ~ 6

Author(s):

R. Haddad ◽

T. Peltz ◽

N. Bertollo ◽

W. R. Walsh ◽

S. Nicklin

Keyword(s):

Mechanical Properties ◽

Flexor Tendon ◽

Tendon Repair ◽

Relative Effect ◽

Flexor Tendon Repair ◽

Polypropylene Monofilament ◽

Single Suture ◽

Biomechanical Strength ◽

Standard Techniques ◽

Repair Techniques

Multiple-strand repair techniques are commonly used to repair cut flexor tendons to achieve initial biomechanical strength. Looped sutures achieve multiple strands with fewer passes and less technical complexity. Their biomechanical performance in comparison with an equivalent repair using a single-stranded suture is uncertain. This study examined the mechanical properties of double-stranded loops of 3-0 and 4-0 braided polyester (Ticron) and polypropylene monofilament (Prolene). Double loops were generally less than twice the strength of a single loop. Ticron and Prolene had the same strengths, but Ticron was stiffer. The 4-0 double loops had significantly higher stiffness than 3-0 single loops. Increasing the size of sutures had a larger relative effect on strength than using a double-stranded suture. However, a double-strand loop had a larger effect on increasing stiffness than using a single suture of a larger equivalent size. Looped suture repairs should be compared with standard techniques using a thicker single suture.

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The Lost Generation: Impact of the 56-hour EWTD on Current Surgical Training

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363510x491105 ◽

2010 ◽

Vol 92 (3) ◽

pp. 102-106 ◽

Cited By ~ 5

Author(s):

CR Chalmers ◽

S Joshi ◽

PG Bentley ◽

NH Boyle

Keyword(s):

Shift Work ◽

Surgical Training ◽

New Deal ◽

Working Hours ◽

Lost Generation ◽

Surgical Trainees ◽

European Working ◽

Working Time Directive ◽

Training Opportunities ◽

The New Deal

The reform of specialist surgical training – the New Deal (1991), the Calman report (1993) and the implementation of the European Working Time Directive (EWTD, 1998) – has resulted in shorter training periods with reduced working hours. The Calman reform aimed to improve and structure training with regular assessment and supervision whereas the New Deal and the EWTD have concentrated predominantly on a reduction in hours. The adoption of full or partial shift work to provide surgical cover at night compliant to a 56-hour working week, as stipulated by phase one of the EWTD, has resulted in daytime hospital attendance for surgical trainees of an average three days per week despite almost universal acknowledgement of the limited training opportunities available at night.

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TP8.2.10 Impact of COVID-19 on General Surgery Training in a University Hospital with Ring Fenced Elective Centre

British Journal of Surgery ◽

10.1093/bjs/znab362.083 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Tanzeela Gala ◽

Quratul Ain ◽

Chekwas Obasi ◽

Hajar Rashid ◽

Sarkhell Radha ◽

...

Keyword(s):

General Surgery ◽

Normal Activity ◽

University Hospital ◽

Surgical Trainees ◽

Higher Surgical Training ◽

Theatre Utilisation ◽

The Impact ◽

Second Wave ◽

Training Opportunities ◽

General Surgery Training

Abstract Aim Higher Surgical training was decimated by the COVID-19 pandemic with cessation of elective care. Trainees raised concerns that the elective restart and need for higher theatre activity to clear backlogs would impact on training opportunities. This study evaluated the resumption of training associated with a ring-fenced elective centre (EC). Methods The EC was established in July 2020 and three time periods were determined: pre-COVID (10/19-2/20), 1st wave of COVID (3/20-7/20) and post EC go-live (8/20-12/20). Data was collated from the E-Logbooks of General Surgery Registrars. Results The normal all-speciality pre COVID theatre-activity averaged 1052 cases/month. During the first wave elective activity decreased to 254 cases/month (24% of normal activity). Within 5 weeks of establishment of the EC, theatre activity was near normal despite a reduced number of theatres (with higher theatre utilisation). Pre COVID, trainees accessed 22.9 cases per month which then dropped to 7.7 cases during the first wave of COVID. Post the go live of the EC, trainees were able to operate on 20 cases per month almost back to normal training levels. Prior to the impact of the second wave, each trainee had developed a deficit of 90 cases during the 5 months pause. Conclusion The ring-fenced elective centre has protected training opportunities for higher surgical trainees. However, the pause in training requires a targeted training recovery plan to overcome the deficit secondary to the first and subsequent waves of COVID to ensure that the JCST target of 1200 cases can be met for CCT.

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