Nicholas C. Oleck, Ralph Erdmann, K. Ravindra, Debra Sudan, Brett T. Phillips, S. Mithani, Detlev Erdmann, Andrew Atia
This four-year follow-up of synchronous abdominal wall allotransplantation (AW-VCA) and small bowel transplantation reveals novel insights and innovations in abdominal wall VCA. The case, involving a 37-year-old male Army veteran, showcases the benefits of AW-VCA in addressing loss of abdominal domain in intestinal transplantation (ITx). The events leading to ultimate rejection of both the AW-VCA and small bowel graft at four years highlights the complex interplay between graft survival, patient compliance, and immunosuppressive management. Notably, a significant discordance between AW-VCA and ITx rejection patterns was identified, questioning the reliability of skin components in AW-VCA as early indicators of ITx rejection. Furthermore, the behavior of the vascularized abdominal fascia, observed post-excision of the small bowel graft, offers new understanding of the immunologic response to fascia-only grafts. This follow-up emphasizes the complexities of graft survival, patient compliance, and immunosuppressive management, underscoring the need for ongoing research and innovation in the field.
{"title":"Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at Four Year Follow Up","authors":"Nicholas C. Oleck, Ralph Erdmann, K. Ravindra, Debra Sudan, Brett T. Phillips, S. Mithani, Detlev Erdmann, Andrew Atia","doi":"10.1055/a-2320-5368","DOIUrl":"https://doi.org/10.1055/a-2320-5368","url":null,"abstract":"This four-year follow-up of synchronous abdominal wall allotransplantation (AW-VCA) and small bowel transplantation reveals novel insights and innovations in abdominal wall VCA. The case, involving a 37-year-old male Army veteran, showcases the benefits of AW-VCA in addressing loss of abdominal domain in intestinal transplantation (ITx). The events leading to ultimate rejection of both the AW-VCA and small bowel graft at four years highlights the complex interplay between graft survival, patient compliance, and immunosuppressive management. Notably, a significant discordance between AW-VCA and ITx rejection patterns was identified, questioning the reliability of skin components in AW-VCA as early indicators of ITx rejection. Furthermore, the behavior of the vascularized abdominal fascia, observed post-excision of the small bowel graft, offers new understanding of the immunologic response to fascia-only grafts. This follow-up emphasizes the complexities of graft survival, patient compliance, and immunosuppressive management, underscoring the need for ongoing research and innovation in the field.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"40 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141007609","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}
Vanesa Lovětínská, Andrej Sukop, Jakub Sulženko, Adam Hora, Matěj Patzelt, B. Kožnar, Karol Kovačič, Michal Kamenistý, Jozef Kučerák
Background: Chronic defects in the lower leg present significant challenges in plastic surgery due to their diverse etiologies and association with impaired peripheral circulation. This study describes the localization of stable perforators and assesses their changing velocities after digital subtraction angiography (DSA). Methods: 10 patients with lower extremity defects requiring DSA, had undergone examinations applying standard methods. The localization of 40 stable perforators originating from three main arteries in crura was performed before and after angiography. Where stenoses or occlusions were observed, percutaneous transluminal angioplasty (PTA) was conducted, and changes in the perforator velocities following reperfusion were measured. Results: Angiographic abnormalities were observed in all cases. Prior to PTA, acoustic Dopplers detected 37 out of 40 perforators (90%), while color-coded sonography detected 35 out of 40 perforators (87.5%). After PTA, these numbers increased to 38 out of 40 (95%) and 37 out of 40 (92.5%) respectively. The mean flow characteristics included the peak systolic velocities (PSV) of 21.9 and 27.2, end-diastolic velocities (EDV) of 9.4 and 11.4 respectively. Post-intervention 16 micro vessels exhibited enlarged lumen diameters ranging from 1 to 3 mm, resulting in increased perfusion values for PSV in 85.2% (21.9/27.2) and EDV in 88.2% (9.4/11.4) of the patients. However, 2 perforators showed decreases in flow velocity after PTA. Conclusion: In most patients with chronic lower leg wounds and other comorbidities, adequate perforators for reconstruction can be identified by using conventional methods. PTA interventions positively impact blood flow in perforators, although they are not necessarily required prior to reconstruction.
{"title":"Stable Arterial Perforators Mapping in Lower Leg Using Color-coded Doppler Sonography, Acoustic Doppler and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Arteriography","authors":"Vanesa Lovětínská, Andrej Sukop, Jakub Sulženko, Adam Hora, Matěj Patzelt, B. Kožnar, Karol Kovačič, Michal Kamenistý, Jozef Kučerák","doi":"10.1055/a-2241-2323","DOIUrl":"https://doi.org/10.1055/a-2241-2323","url":null,"abstract":"Background: Chronic defects in the lower leg present significant challenges in plastic surgery due to their diverse etiologies and association with impaired peripheral circulation. This study describes the localization of stable perforators and assesses their changing velocities after digital subtraction angiography (DSA).\u0000Methods: 10 patients with lower extremity defects requiring DSA, had undergone examinations applying standard methods. The localization of 40 stable perforators originating from three main arteries in crura was performed before and after angiography. Where stenoses or occlusions were observed, percutaneous transluminal angioplasty (PTA) was conducted, and changes in the perforator velocities following reperfusion were measured.\u0000Results: Angiographic abnormalities were observed in all cases. Prior to PTA, acoustic Dopplers detected 37 out of 40 perforators (90%), while color-coded sonography detected 35 out of 40 perforators (87.5%). After PTA, these numbers increased to 38 out of 40 (95%) and 37 out of 40 (92.5%) respectively. The mean flow characteristics included the peak systolic velocities (PSV) of 21.9 and 27.2, end-diastolic velocities (EDV) of 9.4 and 11.4 respectively. Post-intervention 16 micro vessels exhibited enlarged lumen diameters ranging from 1 to 3 mm, resulting in increased perfusion values for PSV in 85.2% (21.9/27.2) and EDV in 88.2% (9.4/11.4) of the patients. However, 2 perforators showed decreases in flow velocity after PTA.\u0000Conclusion: In most patients with chronic lower leg wounds and other comorbidities, adequate perforators for reconstruction can be identified by using conventional methods. PTA interventions positively impact blood flow in perforators, although they are not necessarily required prior to reconstruction.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"32 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442758","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}
Benedictus Ansell Susanto, Nadine Aurelie, William Nathaniel, P. Atmodiwirjo, M. R. Ramadan, R. Djohan
Background: The complexity of plastic microsurgery yields many risks. Robot assistance has been sought to maximize outcome and minimize complications. Reportedly, it offers increased dexterity and flexibility with attenuated human flaws, such as tremors and fatigue. This systematic review will further investigate that claim. Methods: A systematic search was conducted for operative outcomes and operator experience of reconstructive plastic microsurgery compared between conventional and robot-assisted procedures. Data were summarized then meta-analyzed or qualitatively assessed and critically appraised to determine the difference robot assistance offers. Results: This review comprises 4 studies, mainly investigating robot-assisted microvascular anastomosis. Meta-analysis of anastomosis time reveals that robot-assisted takes more time than conventional without offering substantial health-related improvements. However, it offers greater comfort, consistency, and flexibility for operators. Conclusions: Robot assistance lengthens operative times because of its relative lack of implementation and subsequent lack of experienced operators. Times were quick to be improved as repeated procedures were performed and technical complications can be resolved by more experience with robotic equipment. Furthermore, it generally offers better operator experience. Despite this, robot assistance does not offer a better health outcome compared to conventional anastomosis although its benefits may lie in aesthetic outcomes instead. Exploration of that aspect as well as non-summarizable health outcomes are the two primary limitations of this review that warrants further investigation into the subject.
{"title":"Conventional and Robot-Assisted Microvascular Anastomosis - Systematic Review","authors":"Benedictus Ansell Susanto, Nadine Aurelie, William Nathaniel, P. Atmodiwirjo, M. R. Ramadan, R. Djohan","doi":"10.1055/a-2239-5212","DOIUrl":"https://doi.org/10.1055/a-2239-5212","url":null,"abstract":"Background: The complexity of plastic microsurgery yields many risks. Robot assistance has been sought to maximize outcome and minimize complications. Reportedly, it offers increased dexterity and flexibility with attenuated human flaws, such as tremors and fatigue. This systematic review will further investigate that claim.\u0000Methods: A systematic search was conducted for operative outcomes and operator experience of reconstructive plastic microsurgery compared between conventional and robot-assisted procedures. Data were summarized then meta-analyzed or qualitatively assessed and critically appraised to determine the difference robot assistance offers.\u0000Results: This review comprises 4 studies, mainly investigating robot-assisted microvascular anastomosis. Meta-analysis of anastomosis time reveals that robot-assisted takes more time than conventional without offering substantial health-related improvements. However, it offers greater comfort, consistency, and flexibility for operators.\u0000Conclusions: Robot assistance lengthens operative times because of its relative lack of implementation and subsequent lack of experienced operators. Times were quick to be improved as repeated procedures were performed and technical complications can be resolved by more experience with robotic equipment. Furthermore, it generally offers better operator experience. Despite this, robot assistance does not offer a better health outcome compared to conventional anastomosis although its benefits may lie in aesthetic outcomes instead. Exploration of that aspect as well as non-summarizable health outcomes are the two primary limitations of this review that warrants further investigation into the subject.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"47 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139382188","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}
Raja Tiwari, Suvashis Dash, S. Chauhan, Shivangi Saha, Misha Ahir, M. Singhal
Background Extensive crush injuries to forearm pose a unique problem where replantation of uninjured hands to the forearm is not immediately possible due to difficulties in delineating tissue necrosis. Ectopic hand implantation preserves the hand and allows replanting the hand back to the forearm stump, but the tissues preserved in the stump could be inadequate to provide good hand function. In these subsets of cases, forearm reconstruction with composite flaps may offer a better chance of getting good hand function. Methods We present a case of a 29-year-old male, a left-handed factory worker, with severe crushing of the left forearm by a hydraulic pressing machine with a relatively undamaged hand. A three-staged reconstruction was done with the recovery of the left hand after below elbow amputation and replanted to the left lower third of leg. Then a neo-forearm was reconstructed using a functioning free fibula, vastus lateralis muscle, and anterolateral thigh skin flap. Finally, the ectopically banked hand was returned to the reconstructed neo forearm. Results After 2 years follow-up, protective sensation and grip strength of 2 pounds had developed in the hand. The disabilities of arm, shoulder, and hand score was 21, and he was able to perform multiple tasks using the left hand independently and as an assistive hand. Conclusion The consensus on indications of ectopic banking is still open for debate. The addition of our ectopic replantation technique followed by neo-forearm reconstruction and replantation of the hand into the reconstructed neo-forearm, which is a novel concept, will broaden the horizon of reconstructive paradigm.
{"title":"Neo-Forearm Functional Reconstruction after Temporary Ectopic Hand Implantation for Salvage of Hand after Extensive Crush Injury to Forearm","authors":"Raja Tiwari, Suvashis Dash, S. Chauhan, Shivangi Saha, Misha Ahir, M. Singhal","doi":"10.1055/s-0043-1778080","DOIUrl":"https://doi.org/10.1055/s-0043-1778080","url":null,"abstract":"\u0000 Background Extensive crush injuries to forearm pose a unique problem where replantation of uninjured hands to the forearm is not immediately possible due to difficulties in delineating tissue necrosis. Ectopic hand implantation preserves the hand and allows replanting the hand back to the forearm stump, but the tissues preserved in the stump could be inadequate to provide good hand function. In these subsets of cases, forearm reconstruction with composite flaps may offer a better chance of getting good hand function.\u0000 Methods We present a case of a 29-year-old male, a left-handed factory worker, with severe crushing of the left forearm by a hydraulic pressing machine with a relatively undamaged hand. A three-staged reconstruction was done with the recovery of the left hand after below elbow amputation and replanted to the left lower third of leg. Then a neo-forearm was reconstructed using a functioning free fibula, vastus lateralis muscle, and anterolateral thigh skin flap. Finally, the ectopically banked hand was returned to the reconstructed neo forearm.\u0000 Results After 2 years follow-up, protective sensation and grip strength of 2 pounds had developed in the hand. The disabilities of arm, shoulder, and hand score was 21, and he was able to perform multiple tasks using the left hand independently and as an assistive hand.\u0000 Conclusion The consensus on indications of ectopic banking is still open for debate. The addition of our ectopic replantation technique followed by neo-forearm reconstruction and replantation of the hand into the reconstructed neo-forearm, which is a novel concept, will broaden the horizon of reconstructive paradigm.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"18 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140516885","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}
Kai J Wessel, Isa Wendenburg, Shaghayegh Gorji, Alexander Dermietzel, Matthias M Aitzetmueller, Charalampos Varnava, Philipp Wiebringhaus, Marie-Luise Klietz, Tobias Hirsch, Maximilian Kueckelhaus
Background: The concept of robotic microsurgery is becoming increasingly known as several robotic systems tailored to the specific needs of microsurgery are being introduced. Training with these devices is essential to draw conclusions about their potential clinical utility. This study describes the training and learning curve of experienced microsurgeons and complete novices using such a robotic surgical system in combination with an exoscope. Methods: Four experienced microsurgeons and three complete novices performed a total of 62 manual and robot-assisted anastomoses. The time for anastomosis completion, surgeon's satisfaction with the anastomosis and with the robotic system were recorded. The anastomoses’ quality was assessed using the Structured Assessment of Microsurgery Skills (SAMS) and the Anastomosis Lapse Index (ALI). The Rapid Entire Body Assessment (REBA) was used for ergonomics evaluation. Results: All expert microsurgeons and novices improved their performance during training. The average anastomosis time decreased significantly while satisfaction with the anastomosis and robotic system increased significantly over time. Multiple SAMS score parameters increased significantly throughout robotic but not manual training and the ALI score demonstrated more errors in the manual group. The REBA score displayed a significantly lower risk for musculoskeletal disorders in the robotic group. Conclusion: Currently, the first clinical applications of robotic surgical systems specifically designed for microsurgery are being reported. The introduction of such systems into clinical practice can be expected to have a steep learning curve, as demonstrated in our study. Meanwhile, robotic systems for microsurgical procedures may hold great potential for improvement of surgical quality and ergonomics.
{"title":"Combined Application of a Novel Robotic System and Exoscope for Microsurgical Anastomoses: Preclinical Performance","authors":"Kai J Wessel, Isa Wendenburg, Shaghayegh Gorji, Alexander Dermietzel, Matthias M Aitzetmueller, Charalampos Varnava, Philipp Wiebringhaus, Marie-Luise Klietz, Tobias Hirsch, Maximilian Kueckelhaus","doi":"10.1055/a-2199-2584","DOIUrl":"https://doi.org/10.1055/a-2199-2584","url":null,"abstract":"Background: The concept of robotic microsurgery is becoming increasingly known as several robotic systems tailored to the specific needs of microsurgery are being introduced. Training with these devices is essential to draw conclusions about their potential clinical utility. This study describes the training and learning curve of experienced microsurgeons and complete novices using such a robotic surgical system in combination with an exoscope. Methods: Four experienced microsurgeons and three complete novices performed a total of 62 manual and robot-assisted anastomoses. The time for anastomosis completion, surgeon's satisfaction with the anastomosis and with the robotic system were recorded. The anastomoses’ quality was assessed using the Structured Assessment of Microsurgery Skills (SAMS) and the Anastomosis Lapse Index (ALI). The Rapid Entire Body Assessment (REBA) was used for ergonomics evaluation. Results: All expert microsurgeons and novices improved their performance during training. The average anastomosis time decreased significantly while satisfaction with the anastomosis and robotic system increased significantly over time. Multiple SAMS score parameters increased significantly throughout robotic but not manual training and the ALI score demonstrated more errors in the manual group. The REBA score displayed a significantly lower risk for musculoskeletal disorders in the robotic group. Conclusion: Currently, the first clinical applications of robotic surgical systems specifically designed for microsurgery are being reported. The introduction of such systems into clinical practice can be expected to have a steep learning curve, as demonstrated in our study. Meanwhile, robotic systems for microsurgical procedures may hold great potential for improvement of surgical quality and ergonomics.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136376353","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}
K. Bangun, V. Tania, Windy Cendrick, J. Halim, P. Atmodiwirjo, Mohamad Rachadian Ramadan, P. Kreshanti
Introduction. Patients with malignant mandibular reconstructive cases, commonly people often have contralateral normal side to act as a template during preoperative computer-assisted planning. Moreover, the development of Computer-Assisted Design/ Manufacturing Technology aids in the process to produce a template for cutting and/or custom fixation (pre-bending). Therefore, CAD/CAM technology has been greatly used in enhancing accuracy and reducing operation time, and minimizing possible complications due to thorough accurate planning. Method. This study displayed 5 case series incorporating In-House 3D Printed Models cases. 3D imaging was retrieved from CT scan DICOM Files, the file will then be processed to recreate a symmetrical post operative look. Furthermore, the rendered 3D File will be printed with the in-house printer using polylactic acid (PLA) Material. A sterilized 3D printed model will then be used intraoperatively to allow pre-bending of any implants for the case. Then the process, time, and cost of each case were documented. Results 100% success rate in processing all 5 cases into 3D Printed Model. The printing time consumes on average 7 hours,39 minutes (ranging from 5 hours, 59 minutes up to 9 hours, 43 minutes) and costs on average $ 1.83 on each print (ranging from $ 1.69 up to $ 2.10). Conclusion. 3D Printed reconstructed models as guidance to aid the surgeon from visualization of the post-operative look, up to intraoperative pre-bending of the implants used. Thus allowing better efficiency in reducing operation time, better post-operative look, and fewer complications. However, a bigger sample RCT will allow more detailed information.
{"title":"PLA-based In house 3D-printed intraoperative surgical model is a time- and cost-efficient approach for mandibular reconstruction.","authors":"K. Bangun, V. Tania, Windy Cendrick, J. Halim, P. Atmodiwirjo, Mohamad Rachadian Ramadan, P. Kreshanti","doi":"10.1055/a-2162-0460","DOIUrl":"https://doi.org/10.1055/a-2162-0460","url":null,"abstract":"Introduction. Patients with malignant mandibular reconstructive cases, commonly people often have contralateral normal side to act as a template during preoperative computer-assisted planning. Moreover, the development of Computer-Assisted Design/ Manufacturing Technology aids in the process to produce a template for cutting and/or custom fixation (pre-bending). Therefore, CAD/CAM technology has been greatly used in enhancing accuracy and reducing operation time, and minimizing possible complications due to thorough accurate planning. \u0000\u0000Method. This study displayed 5 case series incorporating In-House 3D Printed Models cases. 3D imaging was retrieved from CT scan DICOM Files, the file will then be processed to recreate a symmetrical post operative look. Furthermore, the rendered 3D File will be printed with the in-house printer using polylactic acid (PLA) Material. A sterilized 3D printed model will then be used intraoperatively to allow pre-bending of any implants for the case. Then the process, time, and cost of each case were documented.\u0000\u0000Results 100% success rate in processing all 5 cases into 3D Printed Model. The printing time consumes on average 7 hours,39 minutes (ranging from 5 hours, 59 minutes up to 9 hours, 43 minutes) and costs on average $ 1.83 on each print (ranging from $ 1.69 up to $ 2.10). \u0000\u0000Conclusion. 3D Printed reconstructed models as guidance to aid the surgeon from visualization of the post-operative look, up to intraoperative pre-bending of the implants used. Thus allowing better efficiency in reducing operation time, better post-operative look, and fewer complications. However, a bigger sample RCT will allow more detailed information.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42597808","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}
I. Sethi, J. Mellia, Alexander I. Murphy, Fortunay H. Diatta, Paul A. Asadourian, J. Fischer, S. Azoury, D. Bui
Background: Financial relationships between industry and microsurgeons help facilitate innovation but have the potential to bias a surgeon’s academic work. To better understand industry-academic relationships, this study investigated the association between industry payments made to microsurgeons and their academic influence. Methods: A cross-sectional analysis of microsurgeons at ACGME-accredited plastic surgery residency programs during the 2020-2021 academic year was performed. The Center for Medicare and Medicaid Services’ Open Payments Database was used to collect industry payments (research and non-research related) to each surgeon. Academic influence was measured by h-index and number of publications. Mann-Whitney U and Kruskal Wallis tests were used for statistical analysis. Results: Of the 199 microsurgeons identified, 156 (78.39%) received an industry non-research payment, but 0 (0.0%) received an industry research payment. Surgeons who received any amount of industry payments did not have a higher mean h-index or higher mean number of publications than surgeons with no industry payments. However, surgeons with total industry payments over $10,000 (n=15) had a higher number of publications than surgeons with no industry payments (135.47 vs. 36.02, p=0.0074), $0-$1000 in payments (135.47 vs. 34.37, p=0.0006), and $1,000-$10,000 in payments (135.47 vs. 45.43, p=0.0268). Surgeons with total industry payments over $10,000 also had higher h-indices than surgeons with $0-$1000 in payments (24.4 vs. 10.34, p=0.0039) and $1,000-$10,000 in payments (24.4 vs. 11.34, p=0.0413). Conclusion: Industry funding is associated with higher h-index and higher number of publications for high earners (>$10,000). Private companies may favor these surgeons for their academic expertise.
{"title":"Industry Payments and Academic Influence in Reconstructive Microsurgery","authors":"I. Sethi, J. Mellia, Alexander I. Murphy, Fortunay H. Diatta, Paul A. Asadourian, J. Fischer, S. Azoury, D. Bui","doi":"10.1055/a-2162-0604","DOIUrl":"https://doi.org/10.1055/a-2162-0604","url":null,"abstract":"Background: Financial relationships between industry and microsurgeons help facilitate innovation but have the potential to bias a surgeon’s academic work. To better understand industry-academic relationships, this study investigated the association between industry payments made to microsurgeons and their academic influence. \u0000Methods: A cross-sectional analysis of microsurgeons at ACGME-accredited plastic surgery residency programs during the 2020-2021 academic year was performed. The Center for Medicare and Medicaid Services’ Open Payments Database was used to collect industry payments (research and non-research related) to each surgeon. Academic influence was measured by h-index and number of publications. Mann-Whitney U and Kruskal Wallis tests were used for statistical analysis.\u0000Results: Of the 199 microsurgeons identified, 156 (78.39%) received an industry non-research payment, but 0 (0.0%) received an industry research payment. Surgeons who received any amount of industry payments did not have a higher mean h-index or higher mean number of publications than surgeons with no industry payments. However, surgeons with total industry payments over $10,000 (n=15) had a higher number of publications than surgeons with no industry payments (135.47 vs. 36.02, p=0.0074), $0-$1000 in payments (135.47 vs. 34.37, p=0.0006), and $1,000-$10,000 in payments (135.47 vs. 45.43, p=0.0268). Surgeons with total industry payments over $10,000 also had higher h-indices than surgeons with $0-$1000 in payments (24.4 vs. 10.34, p=0.0039) and $1,000-$10,000 in payments (24.4 vs. 11.34, p=0.0413). \u0000Conclusion: Industry funding is associated with higher h-index and higher number of publications for high earners (>$10,000). Private companies may favor these surgeons for their academic expertise.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45288623","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}
Vesta Brauckmann, J. Mayor, Luisa Ernst, Jennifer Ernst
Background:To enable and further improve microsurgical outcomes, different loupes and optic based microscopes have been proposed in recent years. In amputation surgery continuous progress and prosthetic developments have provided amputees with improved degree of function and quality of life.We present a 17-year-old patient who suffered traumatic loss of the left upper limb and underwent TMR-surgery facilitated by a 3D-robotic-exoscope-system. Methods:The rerouting of the distal ends of the arm-nerves (Targeted Muscle Reinnervation) was performed in the upper limb of a traumatic transhumeral amputee patient using 3D-robotic-exoscope-system (RS, RoboticScope). Perioperative data was collected and compared to standard. Users’ evaluation of the system during the surgical procedure was done using a 5-point-Likert-Scale. Results:Operation time was 311 minutes, the robotic system was used for 101 minutes. Overall users´ evaluation revealed 4,5 for selected items on the Likert-Scale. The evaluation showed similar results in evaluation of the system by main and assistant surgeons. No special training was required beforehand. The bimanual control allowed for improved personal freedom in the surgical field at a comfortable position. The imaging of colors will need future improvements until authentic representation of in situ structures is achieved. Conclusions:Major advantages of a robotic Scope-3D-exoscope-system are improved image quality, ergonomic position, and increased accessibility in a wider operating field due to system implied features. Another benefit is digital documentation, simultaneous education through possibility of capturing images and videos and easy transportation between operating rooms without risk to harm the vulnerable optic. Digital microscopes are still not yet implemented as standard of care.
背景:为了实现和进一步提高显微外科手术的效果，近年来提出了不同的放大镜和光学显微镜。截肢手术的不断进步和假肢的发展为截肢者提供了更好的功能程度和生活质量。我们报告了一位17岁的患者，他遭受了左上肢的创伤性损失，并在3d机器人-外窥镜系统的帮助下接受了tmr手术。方法:采用3d -robot -exoscope系统(RS, RoboticScope)对上肢创伤性肱骨截肢患者进行上肢神经远端改道(靶向肌肉神经移植)。收集围手术期资料并与标准进行比较。手术过程中用户对系统的评价采用5点李克特量表。结果:手术时间为311 min，机器人系统使用时间为101 min。总体用户的评价显示，在李克特量表上，所选项目的得分为4.5分。评价结果显示，主副医师对该系统的评价结果相似。事先不需要特别训练。双手控制允许在一个舒适的位置提高手术领域的个人自由。在真实再现原位结构之前，颜色成像还需要进一步改进。结论:机器人scope- 3d -exoscope系统的主要优点是提高了图像质量，符合人体工程学的位置，并且由于系统隐含的特性而增加了更广泛操作领域的可及性。另一个好处是数字文档，通过捕获图像和视频的可能性进行同步教育，以及在手术室之间方便的运输，而不会有伤害脆弱的视神经的风险。数码显微镜仍未成为医疗标准。
{"title":"How a robotic visualization system can facilitate targeted muscle reinnervation","authors":"Vesta Brauckmann, J. Mayor, Luisa Ernst, Jennifer Ernst","doi":"10.1055/a-2134-8633","DOIUrl":"https://doi.org/10.1055/a-2134-8633","url":null,"abstract":"Background:To enable and further improve microsurgical outcomes, different loupes and optic based microscopes have been proposed in recent years. In amputation surgery continuous progress and prosthetic developments have provided amputees with improved degree of function and quality of life.We present a 17-year-old patient who suffered traumatic loss of the left upper limb and underwent TMR-surgery facilitated by a 3D-robotic-exoscope-system. Methods:The rerouting of the distal ends of the arm-nerves (Targeted Muscle Reinnervation) was performed in the upper limb of a traumatic transhumeral amputee patient using 3D-robotic-exoscope-system (RS, RoboticScope). Perioperative data was collected and compared to standard. Users’ evaluation of the system during the surgical procedure was done using a 5-point-Likert-Scale.\u0000Results:Operation time was 311 minutes, the robotic system was used for 101 minutes. Overall users´ evaluation revealed 4,5 for selected items on the Likert-Scale. The evaluation showed similar results in evaluation of the system by main and assistant surgeons. No special training was required beforehand. The bimanual control allowed for improved personal freedom in the surgical field at a comfortable position. The imaging of colors will need future improvements until authentic representation of in situ structures is achieved. Conclusions:Major advantages of a robotic Scope-3D-exoscope-system are improved image quality, ergonomic position, and increased accessibility in a wider operating field due to system implied features. Another benefit is digital documentation, simultaneous education through possibility of capturing images and videos and easy transportation between operating rooms without risk to harm the vulnerable optic. Digital microscopes are still not yet implemented as standard of care.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44807607","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}
Viola-Antonia Stögner, L. Neubert, Alexander Kaltenborn, B. Wiegmann, C. Krettek, P. M. Vogt, N. Krezdorn
Background: Extremity replantation as well as allotransplantation aim to restore form and function of the amputated limb. Both approaches, however, are clearly limited by the ischemic time. Ex-vivo perfusion (EVP), already well established in the field of solid organ transplantation, represents a promising tool to overcome this restriction. Methods: We have currently established the technical requirements to provide ex-vivo perfusion (EVP) to severed limbs in a clinical hospital setting and hereby report of a 48-hour hypothermic EVP (EVP48) of an upper extremity amputated at the level of the proximal humerus, followed by a 2-hour simulated reperfusion (2SR) with donor blood. Results: Muscle biopsies revealed histopathologically well preserved, vital muscle tissue after EVP24, and partially grouped muscle fiber necrosis with predominantly vital muscle tissue after EVP48 and 2SR. Analyses of perfusate samples showed a marked decline of biochemical muscle damage markers during EVP48. Cytokine analysis disclosed an isolated increase of the pro-inflammatory cytokines interleukine-6, monocyte chemotactic protein-1 and interferon-γ during EVP and 2SR. Magnetic resonance imaging, performed after EVP48, indicated partial muscle necrosis of the intrinsic hand muscles only, whilst no signs for infection or inflammation were present. Conclusion: Our single case experience shows the general feasibility of an amputated limb ex-vivo salvage perfusion setting to allow for delayed replantation up to 24 hours. Nevertheless, an accurate prior planning, is crucial to ensure successful implementation of EVP in the acute clinical setting.
{"title":"48 hour ex-vivo perfusion and two hour simulated reperfusion after a traumatic major amputation of the upper extremity","authors":"Viola-Antonia Stögner, L. Neubert, Alexander Kaltenborn, B. Wiegmann, C. Krettek, P. M. Vogt, N. Krezdorn","doi":"10.1055/a-2004-0041","DOIUrl":"https://doi.org/10.1055/a-2004-0041","url":null,"abstract":"Background: Extremity replantation as well as allotransplantation aim to restore form and function of the amputated limb. Both approaches, however, are clearly limited by the ischemic time. Ex-vivo perfusion (EVP), already well established in the field of solid organ transplantation, represents a promising tool to overcome this restriction.\u0000Methods: We have currently established the technical requirements to provide ex-vivo perfusion (EVP) to severed limbs in a clinical hospital setting and hereby report of a 48-hour hypothermic EVP (EVP48) of an upper extremity amputated at the level of the proximal humerus, followed by a 2-hour simulated reperfusion (2SR) with donor blood.\u0000Results: Muscle biopsies revealed histopathologically well preserved, vital muscle tissue after EVP24, and partially grouped muscle fiber necrosis with predominantly vital muscle tissue after EVP48 and 2SR. Analyses of perfusate samples showed a marked decline of biochemical muscle damage markers during EVP48. Cytokine analysis disclosed an isolated increase of the pro-inflammatory cytokines interleukine-6, monocyte chemotactic protein-1 and interferon-γ during EVP and 2SR. Magnetic resonance imaging, performed after EVP48, indicated partial muscle necrosis of the intrinsic hand muscles only, whilst no signs for infection or inflammation were present.\u0000Conclusion: Our single case experience shows the general feasibility of an amputated limb ex-vivo salvage perfusion setting to allow for delayed replantation up to 24 hours. Nevertheless, an accurate prior planning, is crucial to ensure successful implementation of EVP in the acute clinical setting.\u0000","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41916703","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}
C. Ozturk, Arvind D. Manisundaram, Mariangela Rivera, C. Ozturk, W. Moon
Abstract Background Composite tissue allotransplants are performed for various defects when local, or distant reconstructive options are limited. Though this type of transplant replaces similar tissue, it is complicated by immunosuppression. This limitation may be avoided in monozygotic twins since they share identical genetic code. Free soft tissue transplantation across identical twins has been reported for breast, scalp, and thoracic reconstruction when autologous tissues were insufficient. We present a case of a successful deep inferior epigastric artery perforator (DIEP) flap transplantation in monozygotic twins. Methods The recipient twin was a patient with history of breast cancer and failed prosthetic reconstruction. She desired autologous reconstruction with a DIEP flap but had insufficient donor tissue. She refused alternative sites; however, she had an identical twin willing to donate her excess abdominal tissue. The twins underwent deoxyribonucleic acid testing, human leukocyte antigen/blood type testing, and screening for communicable diseases. Results The twins were found to have greater than 99.99% probability of being monozygotic twins. A bipedicled conjoined DIEP was harvested from donor twin and transplanted to recipient twin. Immunosuppressive regimen was not utilized. Patients healed uneventfully and are currently 5 years postop without long-term complications. Conclusion Isogeneic flap transplant is a viable option to consider when autologous tissues are restricted, and monozygotic twins are present. Appropriate counseling of twins is critical for a successful and satisfactory outcome.
{"title":"DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review","authors":"C. Ozturk, Arvind D. Manisundaram, Mariangela Rivera, C. Ozturk, W. Moon","doi":"10.1055/a-2086-5667","DOIUrl":"https://doi.org/10.1055/a-2086-5667","url":null,"abstract":"Abstract Background Composite tissue allotransplants are performed for various defects when local, or distant reconstructive options are limited. Though this type of transplant replaces similar tissue, it is complicated by immunosuppression. This limitation may be avoided in monozygotic twins since they share identical genetic code. Free soft tissue transplantation across identical twins has been reported for breast, scalp, and thoracic reconstruction when autologous tissues were insufficient. We present a case of a successful deep inferior epigastric artery perforator (DIEP) flap transplantation in monozygotic twins. Methods The recipient twin was a patient with history of breast cancer and failed prosthetic reconstruction. She desired autologous reconstruction with a DIEP flap but had insufficient donor tissue. She refused alternative sites; however, she had an identical twin willing to donate her excess abdominal tissue. The twins underwent deoxyribonucleic acid testing, human leukocyte antigen/blood type testing, and screening for communicable diseases. Results The twins were found to have greater than 99.99% probability of being monozygotic twins. A bipedicled conjoined DIEP was harvested from donor twin and transplanted to recipient twin. Immunosuppressive regimen was not utilized. Patients healed uneventfully and are currently 5 years postop without long-term complications. Conclusion Isogeneic flap transplant is a viable option to consider when autologous tissues are restricted, and monozygotic twins are present. Appropriate counseling of twins is critical for a successful and satisfactory outcome.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e66 - e72"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48579759","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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