Pub Date : 2017-10-11DOI: 10.24983/scitemed.imj.2017.00037
S. Eisenhardt, J. Kiefer, H. Zajonc, A. Momeni, G. Stark
Health care systems in many countries are confronted with increasing economic limitations. Thus, complex microsurgical procedures and extensive rehabilitation programs are poorly compensated. However, this case demonstrates a dramatic reduction of socioeconomic expenses by allowing a potential radiocarpal amputee to return to work for another estimated 30 years.
{"title":"Staged Hand Salvage and Reconstruction with Three Free Tissue Transfers: A Ten-year Follow-up","authors":"S. Eisenhardt, J. Kiefer, H. Zajonc, A. Momeni, G. Stark","doi":"10.24983/scitemed.imj.2017.00037","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2017.00037","url":null,"abstract":"Health care systems in many countries are confronted with increasing economic limitations. Thus, complex microsurgical procedures and extensive rehabilitation programs are poorly compensated. However, this case demonstrates a dramatic reduction of socioeconomic expenses by allowing a potential radiocarpal amputee to return to work for another estimated 30 years.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114909634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-03DOI: 10.24983/SCITEMED.IMJ.2017.00036
Yen-Chou Chen, M. Scaglioni
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.
{"title":"The Lateral Plantar Artery as Recipient Vessel for Microsurgical Lateral Plantar Forefoot Reconstruction: Case Report","authors":"Yen-Chou Chen, M. Scaglioni","doi":"10.24983/SCITEMED.IMJ.2017.00036","DOIUrl":"https://doi.org/10.24983/SCITEMED.IMJ.2017.00036","url":null,"abstract":"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.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121495535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-28DOI: 10.24983/SCITEMED.IMJ.2017.00023
T. Chang
A Fantastic platform for learning, professional development, and camaraderie. It's all just a few clicks away.
一个学习、专业发展和友爱的绝佳平台。只需点击几下鼠标。
{"title":"Knowledge Revolution through Online Interactive Platform: International Microsurgery Club","authors":"T. Chang","doi":"10.24983/SCITEMED.IMJ.2017.00023","DOIUrl":"https://doi.org/10.24983/SCITEMED.IMJ.2017.00023","url":null,"abstract":"A Fantastic platform for learning, professional development, and camaraderie. It's all just a few clicks away.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"2 2-4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114025473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-09DOI: 10.24983/scitemed.imj.2017.00022
Chih-Sheng Lai
ver 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. I started using the Da Vinci Surgical System since May 2013 and applied it to patients who needed free flap reconstruction after the oropharyngeal cancer resection. All the tumors resected without the lip-splitting and mandibulotomy, and the defects were reconstructed by free radial forearm fasciocutaneous flaps. The microvascular anastomoses of the radial artery to the recipient artery, and one venae comitante to the recipient vein in the neck area were performed using a standard operating microscope. The anastomosis of another venae comitante to the recipient vein was performed robotically (Figure 1). Adequate microsurgery training is necessary to perform this procedure. I used visual cues to determine the tension while tying the knots. It is a crucial fact that a superior tactile sense of microsurgical manipulation is essential for this maneuver. The lack of haptic feedback when performing vascular anastomosis can be overcome by practicing visual cues. With the existing limited experience (1 artery and 9 veins), it is possible to perform microsurgical vascular suture using Da Vinci system, which achieves a patent and successful microvascular anastomosis. With the invention of finer devices, the standard operating microscope may be replaced by Da Vinci robotic surgical system. Then, using 4-0 Monocryl sutures, which were manipulated by the Da Vinci system, the revascularized radial forearm flap was inset into the deepest portion of the oropharyngeal defect (Figure 2). Interrupted sutures were delivered by robotic arm-powered needle drivers (2 Black Diamond micro needle drivers, Intuitive Surgical). The Da Vinci Surgical System made it possible to reach difficult areas without using the jaw-splitting approach. Besides, it provided a high-resolution 3D stereoscopic view of the back of the mouth and throat. In our study, we recruited 47 people who underwent reconstructive operations using a free radial forearm fasciocutaneous flap for oropharyngeal defects (14 robot-assisted and 33 conventional reconstructions). Our study revealed that there was no significant difference in complications or revision rates between the robot-assisted and conventional oropharyngeal reconstructions. The functional outcomes of robot-assisted reconstructions were superior to those of conventional reconstructions. The functional outcomes were assessed using the Functional Intraoral O SciTeMed Publishing Group EDITORIAL
{"title":"Experience with Robotic-assisted Microsurgery","authors":"Chih-Sheng Lai","doi":"10.24983/scitemed.imj.2017.00022","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2017.00022","url":null,"abstract":"ver 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. I started using the Da Vinci Surgical System since May 2013 and applied it to patients who needed free flap reconstruction after the oropharyngeal cancer resection. All the tumors resected without the lip-splitting and mandibulotomy, and the defects were reconstructed by free radial forearm fasciocutaneous flaps. The microvascular anastomoses of the radial artery to the recipient artery, and one venae comitante to the recipient vein in the neck area were performed using a standard operating microscope. The anastomosis of another venae comitante to the recipient vein was performed robotically (Figure 1). Adequate microsurgery training is necessary to perform this procedure. I used visual cues to determine the tension while tying the knots. It is a crucial fact that a superior tactile sense of microsurgical manipulation is essential for this maneuver. The lack of haptic feedback when performing vascular anastomosis can be overcome by practicing visual cues. With the existing limited experience (1 artery and 9 veins), it is possible to perform microsurgical vascular suture using Da Vinci system, which achieves a patent and successful microvascular anastomosis. With the invention of finer devices, the standard operating microscope may be replaced by Da Vinci robotic surgical system. Then, using 4-0 Monocryl sutures, which were manipulated by the Da Vinci system, the revascularized radial forearm flap was inset into the deepest portion of the oropharyngeal defect (Figure 2). Interrupted sutures were delivered by robotic arm-powered needle drivers (2 Black Diamond micro needle drivers, Intuitive Surgical). The Da Vinci Surgical System made it possible to reach difficult areas without using the jaw-splitting approach. Besides, it provided a high-resolution 3D stereoscopic view of the back of the mouth and throat. In our study, we recruited 47 people who underwent reconstructive operations using a free radial forearm fasciocutaneous flap for oropharyngeal defects (14 robot-assisted and 33 conventional reconstructions). Our study revealed that there was no significant difference in complications or revision rates between the robot-assisted and conventional oropharyngeal reconstructions. The functional outcomes of robot-assisted reconstructions were superior to those of conventional reconstructions. The functional outcomes were assessed using the Functional Intraoral O SciTeMed Publishing Group EDITORIAL","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125005462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-02DOI: 10.24983/SCITEMED.IMJ.2017.00021
Y. Hsieh, Che-Hsiung Lee, Soo-Ha Kwon, T. Chang
A novel technique of sequential ETS micro-venous anastomoses using three vessel loops for IJV occlusion and a single vascular clamp to retract and hold the anastomoses sites in position.
{"title":"Chang’s Technique of Sequential End-to-Side Microvascular Anastomosis","authors":"Y. Hsieh, Che-Hsiung Lee, Soo-Ha Kwon, T. Chang","doi":"10.24983/SCITEMED.IMJ.2017.00021","DOIUrl":"https://doi.org/10.24983/SCITEMED.IMJ.2017.00021","url":null,"abstract":"A novel technique of sequential ETS micro-venous anastomoses using three vessel loops for IJV occlusion and a single vascular clamp to retract and hold the anastomoses sites in position.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"317 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123635453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-04DOI: 10.24983/SCITEMED.IMJ.2017.00018
D. Chuang
Professor David Chwei-Chin Chuang sincerely welcomes you to join them for this instructional course on Nov. 13-16, 2017 at Chang-Gung Memorial Hospital.
David Chwei-Chin Chuang教授诚挚地欢迎您于2017年11月13-16日在长庚纪念医院参加本次教学课程。
{"title":"Welcome Message for the Second Instructional Course for Adult Brachial Plexus Injuries","authors":"D. Chuang","doi":"10.24983/SCITEMED.IMJ.2017.00018","DOIUrl":"https://doi.org/10.24983/SCITEMED.IMJ.2017.00018","url":null,"abstract":"Professor David Chwei-Chin Chuang sincerely welcomes you to join them for this instructional course on Nov. 13-16, 2017 at Chang-Gung Memorial Hospital.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114306398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-09DOI: 10.24983/SCITEMED.IMJ.2017.00007
T. Huynh
lobally, microsurgery has advanced great strides on the path of development. Microsurgery has become one of the routine approaches of treatment in many resource-abundant surgical centers, where a countless number of patients are daily treated for their injuries or defects by this technique. The progress of microsurgery in developing low-income countries is very much slower compared to that in the developed countries. The implementation and development of microsurgery in resource-limited settings are really tough because of so many obstacles. The initial investment, which involves purchase of equipment, such as surgical microscopes, specialized micro-instrument sets, etc., is quite expensive. In addition, consumable supplies, such as microsurgical sutures, micro-hemoclip, as well as post-operative monitoring devices, are also very costly, and some of them are not even available in resource-limited settings. Training and development of skills of microsurgical surgeons are also significant issues. Microsurgery is a technical skill that requires specialized training and practice. Hence, in order to perform micro-surgical techniques with high efficiency, the young microsurgical surgeons, subsequent to their basic training courses, must participate in many advanced courses. It is most important that they must practice their skills regularly. The specific skills in microsurgery include both microsurgical anastomosis as well as microsurgical dissection. Not to mention that successful outcomes require something more than just the skills used under the microscope. In order to maintain and improve these skills, the same should, preferably, be practiced on real patients. However, there is a paradox that, according to minimum standards of medical ethics, it is difficult to be accepted when we follow a certain therapy for our patients, while we cannot guarantee that the outcomes from this therapy are the best, with our capacity. Experimental micro-surgical models may be considered as the alternative. Here again, there are many complications. The living animal models have great advantages, such as closer to reality and allowing to practice the skills of both microsurgical anastomosis and microsurgical dissection. However, they are expensive, bulky and inconvenient; and hence it is really difficult to continue frequently in resourcelimited settings. On the other hand, the non-living models are cheap, flexible and easier to apply, but the efficiency of skill improvement is not high and practically not allowing to practice the skill of microsurgical dissection. Training and organizing of microsurgical teams are also difficult. Since microsurgery is a collective work, it is not possible to develop microsurgery regularly by relying on some individually trained microsurgeons. In fact, it is not easy to train microsurgical teams synchronously in developing countries. The necessities for application of microsurgical techniques for treatment of patients are real and not
{"title":"Microsurgery Practice in Developing Countries","authors":"T. Huynh","doi":"10.24983/SCITEMED.IMJ.2017.00007","DOIUrl":"https://doi.org/10.24983/SCITEMED.IMJ.2017.00007","url":null,"abstract":"lobally, microsurgery has advanced great strides on the path of development. Microsurgery has become one of the routine approaches of treatment in many resource-abundant surgical centers, where a countless number of patients are daily treated for their injuries or defects by this technique. The progress of microsurgery in developing low-income countries is very much slower compared to that in the developed countries. The implementation and development of microsurgery in resource-limited settings are really tough because of so many obstacles. The initial investment, which involves purchase of equipment, such as surgical microscopes, specialized micro-instrument sets, etc., is quite expensive. In addition, consumable supplies, such as microsurgical sutures, micro-hemoclip, as well as post-operative monitoring devices, are also very costly, and some of them are not even available in resource-limited settings. Training and development of skills of microsurgical surgeons are also significant issues. Microsurgery is a technical skill that requires specialized training and practice. Hence, in order to perform micro-surgical techniques with high efficiency, the young microsurgical surgeons, subsequent to their basic training courses, must participate in many advanced courses. It is most important that they must practice their skills regularly. The specific skills in microsurgery include both microsurgical anastomosis as well as microsurgical dissection. Not to mention that successful outcomes require something more than just the skills used under the microscope. In order to maintain and improve these skills, the same should, preferably, be practiced on real patients. However, there is a paradox that, according to minimum standards of medical ethics, it is difficult to be accepted when we follow a certain therapy for our patients, while we cannot guarantee that the outcomes from this therapy are the best, with our capacity. Experimental micro-surgical models may be considered as the alternative. Here again, there are many complications. The living animal models have great advantages, such as closer to reality and allowing to practice the skills of both microsurgical anastomosis and microsurgical dissection. However, they are expensive, bulky and inconvenient; and hence it is really difficult to continue frequently in resourcelimited settings. On the other hand, the non-living models are cheap, flexible and easier to apply, but the efficiency of skill improvement is not high and practically not allowing to practice the skill of microsurgical dissection. Training and organizing of microsurgical teams are also difficult. Since microsurgery is a collective work, it is not possible to develop microsurgery regularly by relying on some individually trained microsurgeons. In fact, it is not easy to train microsurgical teams synchronously in developing countries. The necessities for application of microsurgical techniques for treatment of patients are real and not","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115643072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.24983/scitemed.imj.2022.00162
M. Sethu
{"title":"A Simple and Innovative Technique to Offload the Microsurgical Loupe","authors":"M. Sethu","doi":"10.24983/scitemed.imj.2022.00162","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2022.00162","url":null,"abstract":"","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128966973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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