USE OF A COMBINATION OF TWO IPSILATERAL FLAPS TO COVER POST TRAUMATIC LEG DEFECTS

INTRODUCTION-With advancement in the microsurgical techniques the free tissue transfer has become the rst choice to manage large leg defects which cannot be covered with a local ap.The other option is the cross leg ap.Free aps need an expert team, expensive instruments and plenty of time. Cross leg aps lead to a difcult postoperative period for the patient. When the tissues surrounding the defect are healthy and a careful planning is done, a combination of two local aps which are otherwise used singly for smaller defects may obviate the need for a free or cross leg ap in certain cases.In this study we evaluated the patients who had undergone a combination of gastrocnemius muscle and fasciocutaneous aps for covering the large leg defects. AIMS AND OBJECTIVES-The aim is to study the role of a combination of two local aps to provide cover for the large leg defects. MATERIAL AND METHODS-A retrospective analysis of 30 patients operated from June 2016 to July 2021 for the leg defects rd involving the upper 2/3 of the leg was done.In these patients the upper half of the defects was covered with gastrocnemius muscle ap and the lower half was covered with inferiorly based fasciocutaneous ap. All patients had been followed till the wound cover became stable. RESULTS-All patients were males between the age group of 16 to 46 years. Leg defects were exposed tibia or implant and were post-traumatic in all the cases. Size of the defects ranged from 16cm to 18cm. In all the patients both aps survived well. Two patients had marginal necrosis of fasciocutaneous ap and one had discharge from underneath the muscle ap but were managed conservatively. CONCLUSION- A combination of gastrocnemius muscle and fasciocutaneous aps is a safeoption for covering large leg rd defects involving the upper 2/3 where surrounding skin and muscles are healthy

Advances in surgical treatment of lymphedema

An estimated 250 million people worldwide suffer from lymphedema. In the past, the firstline option for treatment was nonsurgical management, either in the form of compression garments or wrapping, or comprehensive decongestive therapy, with debulking surgery reserved for the more advanced cases. However, with improvements in microsurgical techniques and imaging modalities, surgical intervention is increasingly being utilized. This review highlights recent advancements in the surgical treatment of lymphedema, specifically focusing on improvements in imaging, surgical techniques, and prevention of lymphedema.

P.181 High-Fidelity Simulation-Based Microsurgical Training for Neurosurgical Residents

Background: Microsurgical techniques remain a cornerstone of neurosurgical training. Despite this, neurosurgical microvascular case volumes are decreasing as endovascular and minimally invasive options expand. As such, educators are looking towards simulation to supplement operative exposure. We review a single institution’s experience with a comprehensive, longitudinal microsurgical simulation training program, and evaluate its effectiveness. Methods: Consecutive postgraduate year 2 (PGY-2) neurosurgery residents completed a one-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat femoral vessel training modules were used. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Results: Eighteen participants completed 107 microvascular anastomoses during the study. There was significant improvement in six measurable skills during the curriculum. Mean overall score was significantly higher on the fifth attempt compared to the first attempt for all 3 live anastomotic modules (p<0.001). Each module had a different improvement profile across the skills assessed. The greatest improvement was observed during artery-to-artery anastomosis. Conclusions: This high-fidelity microsurgical simulation curriculum demonstrated a significant improvement in the six microneurosurgical skills assessed, supporting its use as an effective teaching model. Transferability to the operative environment is actively being investigated.

Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors

Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.

Complete Removal of Bilateral Clinoidal Meningiomas Through a Pterional Approach: 3-Dimensional Operative Video

Surgical removal of anterior clinoidal meningiomas remains a challenge because of its complicated relationship with surrounding vascular and neural structures.1-3 This is a 39-yr-old female, with headaches, neurofibromatosis type 2, and history of 3 previous brain surgeries. The patient gave the consent to use the images and surgical video. In the imaging control, the growth of bilateral anterior clinoidal meningiomas was observed. A right pterional approach and extradural anterior clinoidectomy was performed, and a complete resection of bilateral clinoidal meningiomas was achieved obtaining a Simpson scale resection grade 1. The patient evolved without neurological deficits after the surgery, and the postoperative magnetic resonance imaging (MRI) evidenced a complete bilateral resection of the clinoidal meningiomas. Clinoidal meningiomas are the unique subset of tumors because of their close proximity to neurovascular structures and can be safely excised with minimal morbidity and mortality using microsurgical techniques.3-5 In rare cases of bilateral anterior clinoidal meningiomas such as the case presented, we recommend detailed neuroimaging analysis and consider the possibility to resect both in a single approach.

Harnessing 3D collagen hydrogel-directed conversion of human GMSCs into SCP-like cells to generate functionalized nerve conduits

Achieving a satisfactory functional recovery after severe peripheral nerve injuries (PNI) remains one of the major clinical challenges despite advances in microsurgical techniques. Nerve autografting is currently the gold standard for the treatment of PNI, but there exist several major limitations. Accumulating evidence has shown that various types of nerve guidance conduits (NGCs) combined with post-natal stem cells as the supportive cells may represent a promising alternative to nerve autografts. In this study, gingiva-derived mesenchymal stem cells (GMSCs) under 3D-culture in soft collagen hydrogel showed significantly increased expression of a panel of genes related to development/differentiation of neural crest stem-like cells (NCSC) and/or Schwann cell precursor-like (SCP) cells and associated with NOTCH3 signaling pathway activation as compared to their 2D-cultured counterparts. The upregulation of NCSC-related genes induced by 3D-collagen hydrogel was abrogated by the presence of a specific NOTCH inhibitor. Further study showed that GMSCs encapsulated in 3D-collagen hydrogel were capable of transmigrating into multilayered extracellular matrix (ECM) wall of natural NGCs and integrating well with the aligned matrix structure, thus leading to biofabrication of functionalized NGCs. In vivo, implantation of functionalized NGCs laden with GMSC-derived NCSC/SCP-like cells (designated as GiSCs), significantly improved the functional recovery and axonal regeneration in the segmental facial nerve defect model in rats. Together, our study has identified an approach for rapid biofabrication of functionalized NGCs through harnessing 3D collagen hydrogel-directed conversion of GMSCs into GiSCs.

Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

APPLICATION MAXILLOFACIAL MICROSURGERY AT HANOI NATIONAL HOSPITAL OF ODONTO-STOMATOLOGY

Background: Microsurgery is a highly complex technique that requires specialized equipment and steady surgical techniques. This is a retrospective review of the development progress of microsurgical techniques at Hanoi National Hospital of Odonto-Stomatology (NHOS) during the past 12 years. Methods: Retrospective study assessing the training and developing process of microsurgical techniques at NHOS in 12 years. Results: NHOS has performed 665 microsurgical flaps reconstructions after surgical removal of large tumors in maxillomandibular area. 441 fibular free flaps were harvested for mandibular reconstructions after resections of ameloblastoma and osteofibroma. 4 fibular flaps were used for maxillary reconstructions. 119 osteocutaneous fibular free flaps were harvested for mandibular reconstructions in oral cancer surgeries. 83 lateral arm flaps and 13 anterolateral thigh flaps reconstructions were performed following cancer ablations. 5 patients underwent reconstruction after cancer resection with 2 fibular free flaps and anterolateral thigh flaps. Success rate is 654/665 (98.35%). Conclusion: The implementation of microsurgery technique at NHOS has been carried out for only 12 years but rapid and significant progress has been made. Free flap reconstruction is a flexible reconstructive option to restore essential functions and aesthetics of the facial area and to improve the patient's quality of life.