Femoral-to-popliteal/distal bypass surgery is a procedure used to treat femoral artery disease. It is performed to bypass the narrowed or blocked portion of the main artery of the leg, redirecting blood through either a transplanted healthy blood vessel or through a man-made graft material. This vessel or graft is sewn above and below the diseased artery such that blood flows through the new vessel or graft. The bypass material used can be either the great saphenous vein from the same leg or a synthetic polytetrafluoroethylene (PTFE) or Dacron graft.
This procedure is recommended for patients with peripheral vascular disease for whom medical management has not improved symptoms, for those with leg pain at rest that interferes with quality of life and ability to work, for non-healing wounds, and for infections or gangrene of the leg where there is a danger of loss of limb caused by decreased blood flow. This article demonstrates how to perform femoral artery cut-down and proximal anastomosis procedure in a cadaver. This procedure is commonly used when performing a femoral-popliteal below the knee bypass to restore blood flow to areas affected by arterial blockages or injuries․
Skin is the largest organ by surface area of the body and is essential to prevent dehydration as the first barrier to infection, permit unrestricted movement, and provide a normal profile and appearance. A skin graft is a paper-thin piece of skin that has no fat or other body tissues attached and has been completely removed from its blood supply. Therefore, a skin graft can be transferred anywhere in the body as long as where placed, the so-called recipient site, does have a sufficient blood supply to nourish the skin until new blood vessels can grow into it within a short timeframe. Otherwise, if that does not occur, the graft will shrivel up and die. The downside even of a successful skin graft is the variable final color and inharmonious appearance of the skin, a tendency to contract possibly causing deformities especially limiting motion across joints, and similar healing issues at a second wound, that is the donor site of the graft itself. Nevertheless, this is a rapidly performed surgical procedure requiring but the simplest of instrumentation for the harvest of that graft that can then permit replacement of extensive skin deficiencies. In this video article, these virtues are displayed as a split-thickness skin graft is used to replace the skin missing following the removal of a large squamous cell skin cancer of the forearm.
This video outlines the surgical steps involved in the microsurgical resection of an intracranial dural arteriovenous fistula (dAVF) in a 74-year-old male patient, highlighting the importance of meticulous planning, intraoperative imaging, and precise dissection techniques. The patient has previously undergone embolization, but recurrence occurred despite the initial treatment, and patient symptoms liked headaches and weakness restarted. A decision was made to perform microsurgical resection of dAVF. The video provides a comprehensive illustration of this procedure, emphasizing the value of microsurgery as a definitive treatment modality for these challenging clinical scenarios.
Ankle injuries are common, occurring most often among young males and older females. The ankle joint is crucial for stability and gait, making these injuries a significant source of disability.
Ankle injuries are usually treated operatively when there is loss of joint congruity and stability, and in this video, Dr. Agarwal-Harding takes us through the operative fixation of a bimalleolar ankle fracture. He talks about understanding why operative intervention is recommended, techniques involved, and other considerations.
The gold standard for achalasia is surgical correction via laparoscopic Heller myotomy with a partial fundoplication. The goal of this technical report is to illustrate the authors preferred approach to patients with achalasia and to provide the reader with a detailed description of his operative technique, its rationale, and preoperative and postoperative management.
Bilateral Syndactyly Release of Third and Fourth Fingers Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3; Grant Darner4 1Big Rapids Orthopaedics 2Carolina Regional Orthopaedics 3Columbia University 4Duke University School of Medicine
Amniotic band syndrome, or constriction ring syndrome, happens when a developing fetus gets tangled in the fibrous bands of the amniotic sac. Sometimes, fingers and toes can become trapped in these fibrous bands, with results ranging from amputation of the digits, to fusion of the fingers or toes, termed syndactyly. Syndactyly is amongst the most frequent congenital hand anomaly and is termed simple when the digits are connected by soft tissue only, and complex when one or more phalanges are fused. In complicated syndactyly, there are additional bony elements in between the digits making it challenging if not impossible to separate safely.
The patient in this case is a 1-year-old male with complex syndactyly of the left hand and simple syndactyly of the right hand. Here, both sides are released, with the left side involving a full-thickness skin graft taken from the patient’s groin crease. This case was filmed during a surgical mission with the World Surgical Foundation in Honduras.
Revision canal wall down (CWD) mastoidectomy with mastoid obliteration is most often performed to manage persistent otorrhea and debris accumulation in the mastoid bowl following CWD mastoidectomy. In this case, obliteration is performed for persistent otorrhea from the mastoid bowl and revision CWD mastoidectomy is completed to address a new retraction pocket following a prior CWD mastoidectomy for chronic otitis media with cholesteatoma in a 23-year old male.
There have been numerous reported techniques used for mastoid obliteration, and in this case, a posterior periosteal flap is made, and the mastoid cavity is filled with autogenous bone paté. Following obliteration of the mastoid, a perichondrial graft is used to cover the area. In this case, a titanium total ossicular reconstruction prosthesis is used to rebuild the ossicular chain, and a second perichondrial graft is used to reconstruct the tympanic membrane. The canal is packed with Gelfoam to secure the fascial grafts in place. Postoperatively, patients are typically advised to remove their head dressing 24 hours following the surgery and to apply a topical antibiotic ointment daily to a cotton ball in the ear.
Airway Equipment Stephen Estime, MD; Abdullah Hasan Pratt, MD; Nicholas Ludmer, MD UChicago Medicine
Airway trauma is a critical and potentially life-threatening condition, and timely diagnosis and management is imperative for patient survival, as concomitant injuries and nonspecific symptoms may otherwise lead to fatal outcomes. Efficient airway management is paramount to addressing airway trauma, necessitating a comprehensive approach involving timely diagnosis, appropriate interventions, and the use of specialized equipment to ensure optimal patient outcomes.
Prompt and efficient management not only ensures the patient’s immediate survival but also plays a pivotal role in minimizing the impact on respiratory function and overall quality of life. The main objective is to establish a secure and patent airway, enabling efficient ventilation and later surgical repair. This video delivers a thorough and detailed exposition of the equipment utilized in airway management.
Robotic surgery as an approach for bariatric surgery has been a subject of debate for at least two decades since the platform passed FDA approval. One could argue that the exponential growth of robotics in surgery could end such a debate. The robotic platform offers several advantages that are always advertised, but in the morbidly obese population it offers an added advantage. It is arguable that with the advanced ergonomics, superior visual tools, and wristed instruments the robotic platform is superior in its offerings to the surgeon and enables a wider variety of surgeons with variable skill set to adopt minimally-invasive surgery (MIS), especially in bariatrics.
The Sleeve gastrectomy is technically a straightforward procedure to perform and is easier to learn for trainees and novel surgeons. It could, however, pose some challenges especially in patients with increased BMI, which is a huge advantage for the robotic platform as it allows easier exposure and comfort during the operation.
DCR and Nasolacrimal System (Cadaver) Prithwijit Roychowdhury, BS1; C. Scott Brown, MD2; Matthew D. Ellison, MD2 1University of Massachusetts Medical School 2 Department of Otolaryngology, Duke University
Nasolacrimal duct obstruction (NDO) is the most common disorder of the lacrimal system that affects patients of every age and results in excessive tearing (epiphora) and if untreated, painful infection (dacryocystitis). When NDO symptoms progress and can no longer be managed with conservative measures, endoscopic dacryocystorhinostomy (DCR) is indicated.
In this case, DCR exploration of the nasolacrimal anatomy is performed on a cadaver. The typical presentation of NDO is epiphora but the presence of painful swelling of the medial canthus and mucoid or purulent discharge may indicate the presence of dacryocystitis. The approach presented here involves the creation of a mucosal flap and subsequent use of the DCR drill to expose the nasolacrimal duct anatomy.
