Peter Fagenholz, MD Assistant Professor of Surgery Massachusetts General Hospital Harvard Medical School
This patient is a 58-year-old male who was in a motor vehicle accident and developed a persistent necrotic collection adjacent to the pancreatic tail that did not improve with percutaneous drainage. Here, Dr. Peter Fagenholz at MGH performs a pancreatic debridement using sinus tract endoscopy (STE), a minimally-invasive technique for debridement of dead or infected tissue.
STE and other minimally-invasive techniques have significantly decreased morbidity and mortality for patients undergoing intervention for infected pancreatic necrosis. Common management principles include early non-interventional management to allow the necrosis to wall off, initial intervention with minimally-invasive drainage, and minimally-invasive necrosectomy addressing clearly demarcated necrosis.
STE involves the placement of a percutaneous drain followed by fluoroscopically-guided dilation of the drain tract to allow for placement of a working sheath, through which an endoscope can be introduced to debride the peripancreatic necrosis. After debridement, a drain is then replaced through the same tract.
Michael J. Weaver, MD Associate Orthopaedic Surgeon, Brigham and Women’s Hospital Assistant Professor of Orthopedic Surgery, Harvard Medical School Brigham and Women’s Hospital
The patient in this case is an 81-year-old male with dementia who sustained an unwitnessed fall that resulted in a displaced intra-articular distal femur fracture. Here, Dr. Weaver at Brigham and Women’s Hospital repairs the fracture by performing an open reduction and internal fixation with a LISS plate. An anterolateral approach was used to visualize the joint surface and obtain an anatomic reduction of the articular surface, and a percutaneously-placed lateral lock plate was used to bridge the area of comminution while restoring length, alignment, and rotation to hopefully allow for biologic fixation that permits the bone to heal well.
AV fistulas provide the crucial vascular access required for patients receiving hemodialysis, a life-saving procedure for end-stage renal disease. Such patients have irreversible kidney damage and must receive a new kidney. While waiting, patients rely on hemodialysis to filter their blood to stay alive, and AV fistulas provide the sustainable vascular access required for hemodialysis.
Participate in a masterclass with MGH Chief of Surgery, Dr. Keith Lillemoe, as he performs and narrates a complete Whipple procedure in the latest video-article published by JOMI.
The Whipple procedure, or pancreaticoduodenectomy, is most notably known for its use in the treatment of cancer that is confined to the head of the pancreas. Because of the intricate blood supply between the pancreas, duodenum, gallbladder, and common bile duct, these structures must be resected along with the head of the pancreas. The remaining structures must then be carefully and precisely anastomosed in order to preserve digestive functioning.
This procedure is a complex and difficult operation that can have serious risks; however, it is responsible for saving countless lives.
Abstract: Total knee arthroplasty has evolved into a very successful procedure to relieve pain and restore function in the arthritic knee with advanced structural damage. Optimal results are dependent on the restoration of alignment and ligament stability. Operative techniques involve either preservation of the posterior cruciate ligament or substitution of its function through increased prosthetic constraint. The vast majority of knees do not require cruciate substitution to establish appropriate stability and function. This video outlines the operative technique used by the author for posterior cruciate-retaining total knee arthroplasty in a patient with a preoperative varus deformity.
Dr. Li addresses an ACL torn after a pivot shift incident using a BTB autograft. The anteromedial approach to ACL reconstruction offers the advantage of reliably reproducing the native anatomy of the ACL on the femur footprint by drilling the femoral tunnel independently of the tibial tunnel.