PUBLISHED: Mako Robotic-Arm Assisted Total Knee Arthroplasty

Mako Robotic-Arm Assisted Total Knee Arthroplasty
Jeffrey S. Zarin, MD; Gustavo Barrazueta, MD
Tufts Medical Center

Total knee arthroplasty (TKA) has been around for decades and serves as a very successful procedure to alleviate pain and restore function in a knee with advanced degenerative joint disease. Over the years, there have been many advancements in surgical technique and even more so in implant design. One such technological breakthrough in TKA is the use of robotic-arm assistance for enhanced preoperative planning and intraoperative guidance with dynamic joint balancing and bone preparation.

In this video article, Dr. Zarin demonstrates the operative technique he uses in performing a posterior stabilizing TKA in a varus deformity degenerative knee using Mako robotic-arm assistance.

PUBLISHED: Botox Injection

Botox Injection
Charles R. Woodard, MD¹; Alexandra L. Elder, BS²; Helen A. Moses, MD¹; C. Scott Brown, MD¹
¹Duke University Medical Center
²Thomas Jefferson University

Botox injection is one of the most common cosmetic procedures performed. Botox temporarily paralyzes targeted skeletal muscles of the face, reducing the patient’s ability to produce unwanted dynamic wrinkles. Commonly treated areas of the face include the procerus and corrugator supercilii muscles to treat glabellar frown lines, the frontalis muscle to treat horizontal rhytids of the forehead, and the orbicularis oculi muscle to treat “crow’s feet” wrinkles along the lateral aspect of the orbit.

A thorough facial analysis is necessary to develop a treatment plan for each problem area, particularly by engaging the patient to determine what his or her goals for treatment are. Providers must take care when injecting into the face to avoid complications of overtreatment, such as brow ptosis from over-injecting the forehead or elevated brow from over-injecting the periorbital muscles.

PUBLISHED: Local Tissue Rearrangement for Hypertrophic Chemical Burn: Z-Plasty and VY-Plasty

Local Tissue Rearrangement for Hypertrophic Chemical Burn: Z-Plasty and VY-Plasty
Daniel N. Driscoll, MD, FACS¹; Lisa Gfrerer, MD, PhD²; Robert Dabek, MD³; Aleia M. Boccardi*
¹Shriners Hospitals for Children – Boston
²Harvard Plastic Surgery Combined Residency Program
³Massachusetts General Hospital
*Touro University College of Osteopathic Medicine

Hypertrophic scarring following burn injuries has been shown to occur in up to 70% of patients, potentially causing both long-term psychological and physical morbidity. Increased rates of depression and anxiety are seen to arise from aesthetic dissatisfaction, affecting patient rehabilitation and subsequent societal interaction. Mobility is jeopardized from contractures that develop within the damaged tissue, leading to decreased range of motion and function of the area. Both sequelae leave the patient with an overall decreased quality of life.

Surgical techniques involving local tissue rearrangement, including Z-plasty and VY-plasty can be employed to improve both the function and cosmetic effects of burn scars. Essentially, these techniques illicit a decrease in tension through a lengthening of contracted tissue of up to 50–70%, allowing for better static alignment and increased mobility over joint surfaces. This video depicts the combination of both tissue rearrangement techniques as applied to hypertrophic scar contractures resulting from prior burn injuries. These techniques are an invaluable part of a reconstructive surgeons’ armamentarium when approaching scar revision.