This video article demonstrate surgical correction of a severe hand deformity in a teenage girl with spastic hemiplegia. This patient has a non-functioning hand due to severe spasticity. Correction of the deformity is indicated primarily to facilitate hygiene and improve the position of the fingers. In some patients with volitional control, a certain degree of prehension may be achieved. The basic principles of deformity correction include differential sectioning of sublimis and profundus tendons followed by repair in a lengthened position. The first web contracture is released by muscular release and a skin Z-plasty.
Tracheomalacia is a rare congenital condition that results in incompetence of the trachea, the main airway, leading to collapse of the trachea during respiration. Most often this is due to inadequate bone formation in the trachea, and this causes it to be dynamically collapsed, which can result in breathing difficulties for the child. Upper respiratory infections can also be more common. While most cases of tracheomalacia resolve by 18 to 24 months of age, a small percentage either continue or cause such severe breathing or feeding issues that surgical intervention is warranted. In cases where the innominate artery is the cause of compression of the weakened trachea, an aortopexy to elevate the vessel up to the sternum and away from the trachea is performed.
Shoulder Arthroscopy (Cadaver) Patrick Vavken, MD1; Sabah Ali2 1Smith and Nephew Endoscopy Laboratory 2University of Central Florida College of Medicine
Shoulder arthroscopy is one of the most common procedures performed in orthopaedic surgery. It can be utilized to identify various pathologies including rotator cuff tears, degenerative arthritis, subacromial impingement, and proximal humeral fractures. With continued advancement in arthroscopy, patients benefit from smaller incisions, reduced risk of postoperative complications, and faster recovery compared to open surgery.
Shoulder arthroscopy is performed either in the lateral decubitus position or in the beach chair position (BCP) as seen in this video. The BCP provides greater benefits such as decreased neovascularization during portal placement, fewer cases of neuropathies, and reduced surgical time. In addition to position, there are various portals used in shoulder arthroscopy, with the posterior portal being the most common and used in this video. Complication rates from shoulder arthroscopy are low but include shoulder stiffness, iatrogenic tendon injury, and vascular injury. Therefore, proper patient selection, patient positioning, and appropriate portal selection are essential for successful shoulder arthroscopy. This article discusses shoulder arthroscopy and demonstrates the technique on a cadaver shoulder.
Parotid dissection is a delicate surgical procedure that requires a deep understanding of the relevant anatomy and a careful approach to ensure the preservation of critical structures, particularly the facial nerve. The comprehensive overview provided in this video is a valuable resource for understanding the step-by-step process of parotid dissection. The detailed narration and visual references help to reinforce the importance of accurate identification and preservation of the facial nerve, as well as the other key anatomical structures involved in the procedure. This information is crucial for surgeons in training, as well as for experienced practitioners, to ensure the safe and effective removal of parotid gland tumors while minimizing the risk of complications.
Intraventricular Tumor Resection Tyler N. Adams1; Marcus Czabanka, MD2 1Louisiana State University School of Medicine 2Charite Hospital Berlin
This is a case of a 49-year-old patient who presented with persistent headaches with no focal neurologic deficit. An MRI was performed which revealed an intraventricular tumor. The lesion was seen entering the third ventricle and potentially compressing both foramina of Monro. This was further confirmed through coronal reconstruction. The proposed method for tumor removal is an interhemispheric, transcallosal approach.
Central nervous system (CNS) tumors, such as this, are uncommon neoplasms that often present with symptoms like headache, nausea, vomiting, ataxia, vertigo, and papilledema. There is also the possibility of hydrocephalus, as the tumor can obstruct cerebrospinal fluid (CSF) outflow, and the development of seizures. These tumors often grow slowly and can be managed with surgical resection, chemotherapy, and/or stereotactic radiosurgery. For intraventricular tumor resection, the surgical approach can vary based on the tumor location, experience, and preference of the surgeon.
This video presents a case of bilateral open indirect inguinal herniotomy. The patient, a 12-year-old male, presented to the medical facility with complaints of bilateral protruding masses in the inguinal regions. These masses have been causing him discomfort and pain, particularly during physical exertion. Upon palpation, the masses exhibited an elastic consistency, increased in size during bearing in a standing position, and were found to be reducible when the patient was in a supine position. The patient’s mother reported that these bulges have been present since his birth. Following a comprehensive clinical evaluation, a clinical diagnosis of congenital bilateral inguinal hernia was made. Consequently, a decision was made to perform a bilateral open inguinal herniotomy with high ligation of the hernia sac.
This video demonstrates the essential steps of a bilateral indirect inguinal herniotomy in a pediatric patient, highlighting the importance of proper anatomical dissection, identification of crucial structures, and the high ligation technique for successful hernia repair in children. The detailed procedural description, coupled with the emphasis on anatomical landmarks and technical nuances, makes this video a valuable educational resource for surgical trainees, who are learning the principles and techniques of pediatric inguinal hernia repair.
Surgical intervention for aortoiliac occlusive disease (AIOD) remains a vital tool in the management of AIOD. AIOD is caused by occlusion of the infrarenal and/or iliac arteries, often secondary to atherosclerosis. This article presents a case of a young, male patient with a history of familial hyperlipidemia and chronic tobacco use who underwent a thoracofemoral bypass (TFB) procedure via a retroperitoneal approach.
He presented with classic symptoms of bilateral leg pain when walking, nocturnal lower extremity pain, and correlated diminished lower extremity pulses. TFB was the preferred approach due to the aggressive, soft plaque burden extending into the suprarenal aorta, which precluded endovascular repair and would have increased risk for standard infrarenal aortofemoral bypass (AFB). This video and case report present a detailed explanation of a retroperitoneal approach to a TFB procedure.
This cadaveric study aims to provide a detailed overview of the key steps involved in the dissection of the frontal sinus, including the identification of anatomical landmarks, performing of Draf I, II-A, II-B, and III procedures, and the preservation of mucosal structures. The meticulous identification and preservation of crucial anatomical landmarks, such as the frontal sinus outflow tract, the agger nasi, and the vertical lamella of the middle turbinate, are essential for avoiding complications, including injury to the AEA or inadvertent penetration of the cribriform plate.
By familiarizing themselves with the step-by-step approach outlined in this text and the accompanying video, surgeons can enhance their technical proficiency and improve patient outcomes in the management of frontal sinus-related conditions. For medical students and trainees, this video offers an invaluable learning opportunity to develop a deep understanding of frontal sinus anatomy and the nuances of endoscopic dissection techniques. By using this knowledge, healthcare professionals can enhance their surgical skills, improve patient care, and contribute to the advancement of the field of endoscopic sinus surgery.
This comprehensive video is intended to provide a detailed overview of the surgical technique used to repair a right inguinal hernia in Honduras on a 1-year-old boy who presented with a swelling in his scrotum, which had been present since he was two months old. The surgical procedure is narrated by an experienced pediatric surgeon, highlighting the unique challenges and innovative techniques employed in this case, which can be valuable for surgeons facing similar situations. The importance of this video lies in its educational value for surgeons, particularly those involved in surgical missions or practicing in resource-limited settings.
Carotid Endarterectomy (Cadaver) Meghan Robinson1; Laura Boitano, MD2; Samuel Schwartz, MD2 1Lake Erie College of Osteopathic Medicine 2Massachusetts General Hospital
Carotid stenosis is one of the leading causes of ischemic stroke worldwide. In the United States, nearly 800,000 strokes are reported each year, with ischemia accounting for 87% of them, and 15% traced to a carotid origin. Carotid endarterectomy represents an effective surgical treatment for carotid stenosis in preventing the risk of future ischemic stroke. This video-article demonstrates the surgical technique for carotid endarterectomy on a cadaver and discusses a typical case presentation of an individual who could potentially benefit from this procedure.
