Pattern of superficial venous arrangement in cubital fossa among preclinical Nepalese MBBS students at Birat Medical College Teaching Hospital

Background: The superficial veins of the cubital fossa are frequently variable in existence and arrangement. Many clinical procedures, such as reconstructive microsurgery and arterial bypass surgery, as well as intravenous injections or therapy, require the use of superficial veins. Aims and Objective: The aim of the study was to observe and describe the variations in anatomical distribution of the superficial veins of the cubital fossa in Nepalese pre-clinical medical students. Materials and Methods: The cross-sectional study included a total of 98 students between 18 to 24 years of age. A total of 196 anterior aspects of both arms were examined for cubital venous pattern. A tourniquet was applied at the mid-arm and drawing of the pattern of veins was made on a separate unglazed paper. The venous patterns in the cubital fossa were then categorized based on their gender. Results: Six patterns of superficial veins of the cubital fossa were observed. The commonest pattern in both genders was type I pattern. No statistical significant difference was observed between patterns of superficial veins on the right and left cubital fossa (P = 0.728 and 0.825 respectively) in both male and female subjects. Conclusion: Our research showed six venous patterns of superficial veins at the cubital fossa in Nepalese population. Understanding the common anatomy, patterns and variations of superficial vein anastomosis is imperative as this knowledge would help those needing venous access for various medical procedures.

Are “Free Flaps” “Free” Flaps?

Background Even standard microvascular tissue transfers are time consuming, require great skill and intensity, and can be stressful. Not surprisingly, work-related relative value units are considered by many microsurgeons to be suboptimal. Some might even say that “free flaps” indeed really are “free” flaps. Methods A retrospective review of related finances was undertaken for all free flaps performed in a single surgeon private practice during the latest possible year (2014) that included a complete 5-year follow-up to insure receipt of all expected reimbursements from accounts receivable. There were 61 free flaps available; but arbitrarily 12 free flaps were excluded since postmastectomy breast reconstruction always received mandatory insurance payment, as were additional two cases done pro bono as part of an international educational service. This left 47 free flaps to permit determination of gross payments, if any. Results Compensation summated for three distinct time intervals for all free flaps was preoperative: $10,855.92 (mean: $230.98/flap); intraoperative: $117,015.46 (mean: $2,489.69/flap); and postoperative: $45,296.28 (mean: $963.75/flap). Range of gross payment for the free flap portion only was 529.65 to $4,503.71. Total overall revenue received was $173,167.66 (mean: $3,684.42/flap). Conclusion A true benefit cost-analysis even if microsurgery specific expenses could be estimated would be inaccurate, so that mean net income for each free flap could not be determined. Albeit a minimal gross payment was obtained for some free flap procedures, in no instance was there zero reimbursement. Based on that fact, there were no truly “free” free flaps in this private practice experience, which should encourage the younger surgeon to realize that economic viability is possible so that their enthusiasm for reconstructive microsurgery can be sustained.

Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia

Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center. Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23. Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs. Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.

The revolution of reconstructive microsurgery: Dr. Fu Chan Wei and the Chang Gung Memorial Hospital

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The new paradigm on microsurgical education: the international master degree on reconstructive microsurgery

Microsurgery (MS) is a discipline addressed by many specialties and it is our interest to be able to carry out a pedagogical assessment of the Master Degree in Reconstructive Microsurgery (MRM) as a training program in MS.The MRM is a hybrid, blended program (virtual and face-to-face), developed in 12 modules, over a 2-year duration, which completes 2625 hours. This program is directed by recognized professors in the discipline from different parts of the World and enrolls 35 students per edition.The program reserves 35% of the places for students from emerging countries. Once each of the modules has been received and the exams passed, the students will undergo a period of clinical immersion in the reference centers around the world and after defending the research project they will be able to receive the distinction of the Master granted by the Autonomous University of Barcelona (UAB).There have been 11 editions of MRM since 2009 without interruption, with an enrollment of 400 students, 83% received the MRM degree. 65% work as Microsurgeons. 60% were Men and 40%, Women. 32% have become MS leaders in each region.We consider that the MRM is a solid, reproducible and adaptable program that guarantees each one of the pedagogical aspects. The program is unique and brings together all the qualities so that students have the necessary tools and thus make a safe start in MS.

Current aspects of training Ukrainian doctors for reconstructive microsurgery

Modern technologies and the skills of specialists in reconstructive microsurgery make it possible to solve the problem of restoring the lost cover tissues and bone tissues of the skeleton in one stage with the greatest efficiency, as well as to carry out replantation of limbs or their parts. However, the shortage of such specialists is widely recognized, leading to an increase in disability and death, which account for up to 30% of the global burden of the national health service. In the work, which prepared by specialists from the centres of the cities Dnipro and Kiev, the issue of mastering the skills of reconstructive microsurgery by young specialists is considered. The authors conduct a comparative analysis of teaching methods at two bases in Ukraine and two bases in the European Union.At the current level of development of international educational programs of a specialized online community (international microsurgery club), it is possible to improve or master new techniques for a surgeon of any level of basic training. According to the price-quality criterion and geographical location, the Pius Branzeu Center laboratory (Romania), in the context of the globalization of the world economy and the integration of the European Union countries, can be considered as optimal centre for teaching basic skills for residents and young doctors. However, after obtaining these skills, the microsurgeon must continue training in the real clinical conditions of existing centres in Ukraine for obtain practical experience.