PUBLISHED: Split-Thickness Skin Graft for Scar Release, Permanent Pigment Transfer, and Fractional CO2 Laser Therapy

Split-Thickness Skin Graft for Scar Release, Permanent Pigment Transfer, and Fractional CO2 Laser Therapy
Aleia M. Boccardi, DO1Robert J. Dabek, MD2Lisa Gfrerer, MD, PhD3Daniel N. Driscoll, MD, FACS4
1St. John’s Episcopal Hospital
2Massachusetts General Hospital
3Harvard Plastic Surgery Combined Residency Program
4Shriners Hospitals for Children – Boston

Pediatric burns are one of the most common forms of injury affecting children worldwide. Of these, hand involvement occurs in 80–90% of such incidents. With the skin in children already diffusely thinner throughout the body than adults, this provides a particular challenge for areas naturally possessing thinner skin, such as the dorsal hand. There, the cutaneous tissue is the only protection for vital structures in the hand that allow full function, such as extensor tendons, nerves, and vessels. Injury to this area early in life can have a detrimental impact on how the survivor interacts with the physical world, affecting their functional capacity and quality of life.

Here presents a case of burn contractures on the right hand of an 8-year-old boy that will be released using a split-thickness graft, along with a pigment transfer graft for his left knee and fractional CO2 laser therapy over areas of hypertrophic scar tissue on his bilateral upper extremities. The split-thickness graft will greatly decrease the tension built up from the burn contracture, while the fractional CO2 laser procedure can soften the surrounding scar, allowing mild remodeling and increased range of motion.

PUBLISHED: Back Table Setup for an Open Umbilical Hernia Repair

Back Table Setup for an Open Umbilical Hernia Repair
Devon Massey, CSTShirin Towfigh, MD
Beverly Hills Hernia Center

Surgical instrument tables are considered as basic furniture for the operating room (OR). The largest table, typically rectangular or “L”-shaped, serves as a central hub for arranging and storing sterile supplies until needed during surgical procedures. The Mayo stand is an extension of the large table. It is small, height-adjustable, and intended to hang over the operating table and hold instruments and other sterile items for immediate use and within easy reach for the scrub nurse. Both the large table and the smaller Mayo stand are often referred to as back tables.

The specific equipment and arrangement of the back table may vary depending on the type of surgery and the surgeon’s preferences. This video provides a detailed, step-by-step guide to the back table setup for an open umbilical hernia repair surgery. It covers the preparation of the surgical field, the handling of sterile supplies, and the organization of the surgical tray. Additionally, it discusses the importance of adhering to sterile technique and the surgeon’s preferences during the procedure.

PUBLISHED: Laparoscopic Lysis of Adhesions for Closed Loop Small Bowel Obstruction

Laparoscopic Lysis of Adhesions for Closed Loop Small Bowel Obstruction
Jade Refuerzo, BSNicole B. Cherng, MD
UMass Memorial Medical Center

Laparoscopic lysis of adhesions is a minimally-invasive approach to the resolution of a closed loop small bowel obstruction (SBO) due to adhesions. A patient with an SBO can present with nausea, vomiting, abdominal pain, and obstipation. History of prior abdominal surgeries serves as a significant risk factor for development of intra-abdominal adhesions. Imaging using either plain abdominal radiography or computed tomography (CT) can be diagnostic for closed loop SBOs. Conservative management with gastrografin can be considered in some SBOs, but closed loop SBOs are considered surgical emergencies. Utilization of specific signs (two transition points, pneumoperitoneum, signs of bowel ischemia) on imaging and patient presentation can facilitate earlier intervention.

Laparoscopic lysis of adhesions can resolve symptoms through releasing the bowel from the adhesion to improve flow. Lysis of adhesions can be performed open, laparoscopically, or with robotic techniques. This case presents a laparoscopic lysis of adhesions in a patient with a closed loop small bowel obstruction.

PUBLISHED: Surgical Staplers

Surgical Staplers
Brandon Buckner, CST, CRCST
Lamar State College Port Arthur (TX)

For nearly two centuries, surgeons have been using mechanical devices to approximate tissues and facilitate their healing process. Currently, surgical staplers are widely used and have become essential tools in surgery. Staples facilitate rapid wound closure, hence shortening the duration of the surgical procedure. In comparison to intradermal sutures, stapling is associated with better cosmetic outcomes.

Staplers are classified into five categories: circular, linear, linear cutting, ligating, and skin staplers. With distinct names, color-coded features, and variations in length and tissue thickness, each stapler serves a specific purpose in the surgical setting. The distinct characteristics of various tissue types in the human body significantly influence the selection of staples. This video aims to provide a comprehensive overview of stapling instruments and their associated use.

PUBLISHED: Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh
Victoria J. Grille, MDRandy S. Haluck, MD
Penn State Health Milton S. Hershey Medical Center

This video demonstrates the surgical technique for a laparoscopic totally extraperitoneal (TEP) left inguinal hernia repair with mesh. This is a technically challenging operation with a steep learning curve; however, it is one useful option for patients with bilateral hernias, recurrent hernias, or when a minimally-invasive approach is desired. It provides tension-free repair and allows exposure to the entire groin area to evaluate and repair indirect, direct, and femoral hernias. The only absolute contraindication to laparoscopic TEP repairs is the inability to undergo general anesthesia due to significant cardiopulmonary disease or other factors.

PUBLISHED: Combined Thymectomy and Right Lower Lobe Pulmonary Wedge Resection by Thoracoscopy

Combined Thymectomy and Right Lower Lobe Pulmonary Wedge Resection by Thoracoscopy
M. Lucia Madariaga, MDHenning A. Gaissert, MD
Massachusetts General Hospital

With the increasing use of computed tomography (CT) for screening and diagnostic workup, increasing numbers of patients are found to have pulmonary nodules. The patient in this case presented with vision changes, neck weakness, and dysphagia. Workup revealed non-thymomatous myasthenia gravis as well as an incidental right lower lobe lung nodule that was suspicious for malignancy based on imaging characteristics, interval growth, and history of breast cancer.

She required a lung resection for diagnostic and therapeutic purposes. Additionally, a thymectomy was indicated to help control her myasthenia gravis symptoms. Consequently, a combined approach was conducted.