Hand Surgery, Orthopedics, Print Release

PUBLISHED: De Quervain’s Release (Cadaver)

 

De Quervain’s Release (Cadaver)

Asif M. Ilyas, MD, FACS
Rothman Institute at Thomas Jefferson University

Irene Kalbianr
Rothman Institute at Thomas Jefferson University

De Quervain’s release is a surgical procedure performed to curatively treat stenosing extensor tenosynovitis of the first extensor compartment of the wrist after nonoperative management fails. This procedure involves surgical release of the first dorsal compartment with care taken to fully release the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons from their respective sheaths, while protecting the radial sensory nerve, in order to decompress the extensor tendons. This video outlines the operative technique used by Dr. Asif Ilyas at the Rothman Institute for performing a De Quervain’s release on a cadaveric wrist.

 

Hand Surgery, Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Flexor Tendon Repair for a Zone 2 FDP Tendon Laceration

 

Flexor Tendon Repair for a Zone 2 FDP Tendon Laceration

Asif M. Ilyas, MD, FACS
Rothman Institute at Thomas Jefferson University

Chaim Miller
Sidney Kimmel Medical College at Thomas Jefferson University

In this case, Dr. Asif Ilyas at the Rothman Institute presents a zone 2 flexor tendon repair with a 4-0 Ethibond suture with a modified Kessler stitch that resulted in an 8-core strand repair. The procedure was done under wide awake local anesthesia no tourniquet (WALANT) protocol, which among other strengths allows the surgeon to test the repair and set postrehabilitation expectations for the patient.

 

Otolaryngology, Print Release

PUBLISHED: Bonebridge Implant

 

Bonebridge Implant

Scott Brown, MD
Duke University Medical Center

David M Kaylie, MD, MS
Duke University Medical Center

Cecilia G Freeman
Duke University Medical Center

Bone conduction implants can improve hearing in patients with conductive or mixed hearing loss as well as in cases of single-sided deafness (SSD). The patient in this case previously underwent resection of a vestibular schwannoma via a middle fossa craniotomy that ultimately resulted in SSD. Here, Dr. Kaylie at Duke University Medical Center demonstrates the step-by-step surgical technique for the Bonebridge implant to allow sound transmission from the patient’s deaf ear to the contralateral cochlea via bone conduction.

 

General Surgery, Print Release, Uncategorized

PUBLISHED: Altemeier Perineal Proctosigmoidectomy for Rectal Prolapse

 

Altemeier Perineal Proctosigmoidectomy for Rectal Prolapse

Madison S McCarthy
Stanford University School of Medicine

Charlotte M Rajasingh, MD
Stanford University School of Medicine

Brooke Gurland, MD
Stanford University School of Medicine

Full-thickness rectal prolapse occurs when the rectum invaginates into the anal canal and beyond the anal sphincters. The only definitive treatment for rectal prolapse is surgery. Here, Dr. Brooke Gurland at Stanford University Medical Center presents an Altemeier proctosigmoidectomy on an 80-year-old female with full-thickness rectal prolapse. The redundant rectum is delivered and then excised through a transanal approach, and the proximal colon is sutured to the distal end of the rectum.

 

Cardiac Surgery, Print Release, Trauma

PUBLISHED: Introduction to Bedside Cardiac Ultrasound

Introduction to Bedside Cardiac Ultrasound

Allyson Peterson, MD
UChicago Medicine

Nadim Michael Hafez, MD
UChicago Medicine

Point of care cardiac ultrasound is a key diagnostic tool in evaluating any patient who is in extremis. Indications for a bedside cardiac ultrasound include cardiac arrest, unexplained hypotension, syncope, shortness of breath, chest pain, and altered mental status. There are no absolute contraindications for a limited bedside cardiac ultrasound. Point of care cardiac ultrasound mainly consists of four views: the parasternal long, parasternal short, apical four chamber, and subxiphoid views. Here, Dr. Peterson and Dr. Hafez at UChicago Medicine discuss image acquisition, pearls and pitfalls, and pathology for each of these views as an introduction to the bedside cardiac ultrasound.

General Surgery, Ob/Gyn, Print Release, Uncategorized

PUBLISHED: Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

Site-Specific Posterior Colporrhaphy and Perineorrhaphy for Rectocele

Lori R. Berkowitz, MD
Mass General Hospital

Patricia L. Hudson, MD
Massachusetts General Hospital

This patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence. She was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair. Although stress urinary incontinence was demonstrated on urodynamic testing, the decision was made not to proceed with concurrent midurethral sling given her history of pelvic floor dyssynergia and intermittent urinary retention. Here, Dr. Berkowitz and Dr. Hudson at MGH present and demonstrate a site-specific posterior colporrhaphy and perineorrhaphy.

General Surgery, Print Release

PUBLISHED: Shouldice Repair for Left Direct Inguinal Hernia

Shouldice Repair for Left Direct Inguinal Hernia

Michael Reinhorn, MD, FACS
Mass General Brigham – Newton-Wellesley Hospital
Boston Hernia and Pilonidal Center
Tufts University School of Medicine

Divyansh Agarwal, MD
Massachusetts General Hospital

Lauren Ott, PA-C
Mass General Brigham – Newton-Wellesley Hospital
Boston Hernia and Pilonidal Center
Tufts University School of Medicine

In this article, Dr. Michael Reinhorn shows the case of a 51-year-old male who presented with left groin pain and a bulge in the area, worsened while straining or after a long day of physical activity. The patient underwent a mesh-free hernia repair performed via the four-layer Shouldice technique as a 50-minute ambulatory/day-surgery procedure. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.

General Surgery, Ob/Gyn, Print Release, Uncategorized

PUBLISHED: Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Marcus V. Ortega, MD;Emily C. Von Bargen, DO; Liliana Bordeianou, MD

Massachusetts General Hospital

This is the case of an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defacography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen at MGH discuss the decision-making process when treating rectal prolapse and perform a laparoscopic suture rectopexy with culdoplasty, vaginal wall repair, and perineorrhaphy with levator plication.

General Surgery, Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Jonah Poster
Shriners Hospitals for Children – Boston

Jonathan Friedstat, MD
Shriners Hospitals for Children – Boston
Massachusetts General Hospital

Burn scar contracture of the dorsal foot causes metatarsophalangeal joint hyperextension and interphalangeal joint hyperextension. In children, these issues only intensify over time as a child grows. Here, Dr. Friedstat at Shriners Hospitals for Children in Boston presents the case of a young boy who suffered a 32% total body surface area flame burn to his lower back, bilateral buttocks, legs, and feet. This patient had previously undergone a bilateral contracture release of the dorsum of the foot. Because the contractures recurred, another bilateral dorsal foot scar contracture release was performed using a split-thickness 1:1 meshed skin graft harvested from the anterior left thigh.

General Surgery, Print Release

PUBLISHED: Peroral Endoscopic Myotomy (POEM) for Achalasia

Peroral Endoscopic Myotomy (POEM) for Achalasia

Daniel Hashimoto; Ozanan R Meireles, MD; David Rattner, MD
Massachusetts General Hospital

Impaired transit of food and liquid from the esophagus to the stomach results in symptoms of dysphagia, regurgitation, retrosternal fullness/pain, and weight loss. Symptoms can be managed with a range of medical or procedural therapy. However, the best results are obtained from surgical management with myotomy. Here, Drs. Rattner, Meireles, and Hashimoto at MGH perform and demonstrate a peroral endoscopic myotomy (POEM), which emerged as a less invasive manner through which to perform a myotomy and provides relief of dysphagia comparable to laparoscopic Heller myotomy – the current standard of surgical therapy for achalasia.

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