Pub Date : 1900-01-01DOI: 10.24983/scitemed.imj.2023.00174
Mohammad Suleman Bajwa, Muhammad Omar Afzal, Ahmad Hussain, Usman Khalid Farooq, Muhammad Mustehsan Bashir, Farooq Shahzad
Emerging anatomical concepts challenge microsurgical dogma. The current anatomy of the skin and subcutaneous tissue was reviewed with the objective of challenging the existing understanding of fasciocutaneous microanatomy using an updated anatomical model. Numerical anatomical data were compiled and utilized to create an updated and scaled model, defining integumentary neuroarterial, venolymphatic, and connective tis - sue systems. Additionally, a second model detailing the neurovasculature of the head and neck is presented, illustrating the relations of perforator arteries. Microangiosomes, the strength of their connections, and their relation to dissection planes are described. Clinically relevant structures are outlined, along with general principles and regional variations. We explore the viability of dermal plexus flaps and their potential for engraftment through plexus-to-plexus apposition. A comparison is drawn between subdermal and deep-dermal plexi. Furthermore, the peculiarities of head and neck perfusion and lymphatic drainage are discussed. These models inform our approach to dissection planes, fluid injection depths, flap via - bility, neurotization, post-inflammatory hyperpigmentation, tissue engraftment, debulking, and head and neck lymphatic drainage. This illustrated review offers an updated understanding of fasciocutaneous microanatomy and how to safely utilize it.
{"title":"Redefining Fasciocutaneous Microanatomy: An Illustrated Review of Current Concepts and Their Clinical Correlates","authors":"Mohammad Suleman Bajwa, Muhammad Omar Afzal, Ahmad Hussain, Usman Khalid Farooq, Muhammad Mustehsan Bashir, Farooq Shahzad","doi":"10.24983/scitemed.imj.2023.00174","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2023.00174","url":null,"abstract":"Emerging anatomical concepts challenge microsurgical dogma. The current anatomy of the skin and subcutaneous tissue was reviewed with the objective of challenging the existing understanding of fasciocutaneous microanatomy using an updated anatomical model. Numerical anatomical data were compiled and utilized to create an updated and scaled model, defining integumentary neuroarterial, venolymphatic, and connective tis - sue systems. Additionally, a second model detailing the neurovasculature of the head and neck is presented, illustrating the relations of perforator arteries. Microangiosomes, the strength of their connections, and their relation to dissection planes are described. Clinically relevant structures are outlined, along with general principles and regional variations. We explore the viability of dermal plexus flaps and their potential for engraftment through plexus-to-plexus apposition. A comparison is drawn between subdermal and deep-dermal plexi. Furthermore, the peculiarities of head and neck perfusion and lymphatic drainage are discussed. These models inform our approach to dissection planes, fluid injection depths, flap via - bility, neurotization, post-inflammatory hyperpigmentation, tissue engraftment, debulking, and head and neck lymphatic drainage. This illustrated review offers an updated understanding of fasciocutaneous microanatomy and how to safely utilize it.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"155 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":"132814979","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.2022.00167
J. Telich-Tarriba, Guillermo Alvarez, A. Cardenas-Mejia
The field of peripheral nerve surgery has experienced significant growth over the past few years as a result of the development of more effective treatment strategies such as direct nerve coaptation or complex nerve transfers. The majority of reconstructive procedures place a high priority on restoring motor function, however sensory restoration is commonly neglected during these operations. The loss of pro - tective sensation increases the risk of developing injuries to the body, such as corneal ulcers, pressure sores, and hand injuries on the ulnar edge. In addition, the increased risk of developing neuropathic pain or depression adversely impacts the quality of life of patients. Research - ers and clinical centers have shown interest in sensory nerve reconstruction in a variety of anatomical locations. The purpose of the study is to provide a comprehensive review of the various options available for nerve transfers and direct neurotization in various parts of the body.
{"title":"Sensory Nerve Transfers and Direct Neurotization: The New Frontier in Peripheral Nerve Surgery","authors":"J. Telich-Tarriba, Guillermo Alvarez, A. Cardenas-Mejia","doi":"10.24983/scitemed.imj.2022.00167","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2022.00167","url":null,"abstract":"The field of peripheral nerve surgery has experienced significant growth over the past few years as a result of the development of more effective treatment strategies such as direct nerve coaptation or complex nerve transfers. The majority of reconstructive procedures place a high priority on restoring motor function, however sensory restoration is commonly neglected during these operations. The loss of pro - tective sensation increases the risk of developing injuries to the body, such as corneal ulcers, pressure sores, and hand injuries on the ulnar edge. In addition, the increased risk of developing neuropathic pain or depression adversely impacts the quality of life of patients. Research - ers and clinical centers have shown interest in sensory nerve reconstruction in a variety of anatomical locations. The purpose of the study is to provide a comprehensive review of the various options available for nerve transfers and direct neurotization in various parts of the body.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"16 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":"126817735","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.2022.00163
M. Moran-Romero, Francisco Javier López Mendoza
{"title":"Postoperative Monitoring of Free Flaps Using Smartphone Thermal Imaging May Lead to Ambiguous Results: Three Case Reports","authors":"M. Moran-Romero, Francisco Javier López Mendoza","doi":"10.24983/scitemed.imj.2022.00163","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2022.00163","url":null,"abstract":"","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"19 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":"123780992","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.2021.00149
I. Koshima, Hirofumi Imai, Shuhei Yoshida, T. Eldahshoury, S. Nagamatsu, K. Yokota, M. Harima, H. Mizuta, Shuji Yamashita, R. Kannan
{"title":"Development of Tibial Osseo-Periosteal Flap for Complex Nonunions and Bone Defects","authors":"I. Koshima, Hirofumi Imai, Shuhei Yoshida, T. Eldahshoury, S. Nagamatsu, K. Yokota, M. Harima, H. Mizuta, Shuji Yamashita, R. Kannan","doi":"10.24983/scitemed.imj.2021.00149","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2021.00149","url":null,"abstract":"","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"91 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":"133600963","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.2022.00166
Macarena Vizcay, L. Troisi, Alfonso Navia, A. López, G. Nicolas, Ernesto Miranda, G. Pafitanis, J. Berner
Objective: Health services in Latin America have witnessed continuous expansion, improving access for patients requiring treatment for trauma and cancer. However, while demand for complex reconstruction is on the rise, the number of trained microsurgeons remains limited. The aim of this study is to investigate current experiences of plastic surgery residents with regard to microsurgery. It also aims to find out ways through which the number of trained microsurgeons in the region can be increased for better medical care. Methods: A cross-sectional survey was designed to obtain information regarding the exposure and training that plastic surgery residents receive during residency in Latin American countries. We ensured that our procedure followed the data protection rules laid down in the General Data Protection Regulation (GDPR). Results: We requested 129 microsurgeons in Latin American countries to respond to our survey questions. A total of 93 survey responses were received, corresponding to a response rate of 72.1%. An analysis of the survey data showed that in terms of hands-on microsurgical training, 79.6% of the respondents had previous experience of being involved in performing a microsurgical procedure. However, 59.1% of the respondents mentioned that this was part of their formal training program. The majority of respondents (74%) reported that they would not be confident in performing a microsurgical procedure unsupervised. About half, or 48.4% of the respondents said that they would consider applying for a microsurgery fellowship. However, only 63.4% reported that they had access to a fellowship program in their home country. Conclusion: Few resident plastic surgeons in Latin America are able to attain the required level of experience so as to feel comfortable acting as independent microsurgeons. Both time and effort are required to address this problem. A powerful tool to change this situation is to gain access to international microsurgical fellowships. An influx of returning trained microsurgeons can provide two benefits: (a) increasing the caseload in the short run, and (b) improving the training of plastic surgeons for future generations of doctors.
{"title":"Microsurgery Training in Latin America: A Survey of Residents’ Experiences","authors":"Macarena Vizcay, L. Troisi, Alfonso Navia, A. López, G. Nicolas, Ernesto Miranda, G. Pafitanis, J. Berner","doi":"10.24983/scitemed.imj.2022.00166","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2022.00166","url":null,"abstract":"Objective: Health services in Latin America have witnessed continuous expansion, improving access for patients requiring treatment for trauma and cancer. However, while demand for complex reconstruction is on the rise, the number of trained microsurgeons remains limited. The aim of this study is to investigate current experiences of plastic surgery residents with regard to microsurgery. It also aims to find out ways through which the number of trained microsurgeons in the region can be increased for better medical care. Methods: A cross-sectional survey was designed to obtain information regarding the exposure and training that plastic surgery residents receive during residency in Latin American countries. We ensured that our procedure followed the data protection rules laid down in the General Data Protection Regulation (GDPR). Results: We requested 129 microsurgeons in Latin American countries to respond to our survey questions. A total of 93 survey responses were received, corresponding to a response rate of 72.1%. An analysis of the survey data showed that in terms of hands-on microsurgical training, 79.6% of the respondents had previous experience of being involved in performing a microsurgical procedure. However, 59.1% of the respondents mentioned that this was part of their formal training program. The majority of respondents (74%) reported that they would not be confident in performing a microsurgical procedure unsupervised. About half, or 48.4% of the respondents said that they would consider applying for a microsurgery fellowship. However, only 63.4% reported that they had access to a fellowship program in their home country. Conclusion: Few resident plastic surgeons in Latin America are able to attain the required level of experience so as to feel comfortable acting as independent microsurgeons. Both time and effort are required to address this problem. A powerful tool to change this situation is to gain access to international microsurgical fellowships. An influx of returning trained microsurgeons can provide two benefits: (a) increasing the caseload in the short run, and (b) improving the training of plastic surgeons for future generations of doctors.","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"134 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":"125059609","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.2021.00153
I. Koshima, Hirofumi Imai, S. Yoshida, M. Harima, Shuji Yamashita, R. Kannan, T. Eldahshoury
Objective: Joint defects in the fingers due to osteoarthritis are often repaired with joint implants, arthrodesis or by vascularized proximal interphalangeal joint graft. The disadvantage of grafts, however, is that they may damage the donor toe. As a result of the discussion presented in this paper, we present evidence to indicate that vascularized distal interphalangeal joint transfers from the second toe may be able to be used in the reconstruction of these defects by using microsurgical techniques. Methods: In this study, we have operated on four cases of hand osteoarthritis using the technique. The distal interphalangeal joint of the second toe was transferred as a composite flap including tendons and/or digital artery perforator flap. There was a follow up period of three to fourteen months after the surgery. Results: All patients have gained an improved range of motion and stabilization of their joints. There was no skin necrosis or damage to the donor toes, and the function of the remaining proximal interphalangeal joint was preserved. Conclusion: There is evidence that a distal interphalangeal joint transfer can be a less invasive and effective technique for the reconstruction of traumatic proximal interphalangeal complex defects and advanced carpometacarpal arthritis of the thumb. International Microsurgery Journal. 2021;5(2):3 International Microsurgery Journal
{"title":"Free Vascularized Second-Toe Distal Interphalangeal Joint Transfer for Reconstruction of Finger Defects","authors":"I. Koshima, Hirofumi Imai, S. Yoshida, M. Harima, Shuji Yamashita, R. Kannan, T. Eldahshoury","doi":"10.24983/scitemed.imj.2021.00153","DOIUrl":"https://doi.org/10.24983/scitemed.imj.2021.00153","url":null,"abstract":"Objective: Joint defects in the fingers due to osteoarthritis are often repaired with joint implants, arthrodesis or by vascularized proximal interphalangeal joint graft. The disadvantage of grafts, however, is that they may damage the donor toe. As a result of the discussion presented in this paper, we present evidence to indicate that vascularized distal interphalangeal joint transfers from the second toe may be able to be used in the reconstruction of these defects by using microsurgical techniques. Methods: In this study, we have operated on four cases of hand osteoarthritis using the technique. The distal interphalangeal joint of the second toe was transferred as a composite flap including tendons and/or digital artery perforator flap. There was a follow up period of three to fourteen months after the surgery. Results: All patients have gained an improved range of motion and stabilization of their joints. There was no skin necrosis or damage to the donor toes, and the function of the remaining proximal interphalangeal joint was preserved. Conclusion: There is evidence that a distal interphalangeal joint transfer can be a less invasive and effective technique for the reconstruction of traumatic proximal interphalangeal complex defects and advanced carpometacarpal arthritis of the thumb. International Microsurgery Journal. 2021;5(2):3 International Microsurgery Journal","PeriodicalId":252045,"journal":{"name":"International Microsurgery Journal","volume":"14 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":"125966934","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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