All posts by Chris Boisvert

PUBLISHED: Total Knee Arthroplasty

Total Knee Arthroplasty
Thomas S. Thornhill, MDDavid J. Lee, MD
Brigham and Women’s Hospital

Total knee replacement is one of the most common orthopaedic procedures performed in the United States. The most common indication for total knee replacement is osteoarthritis. Clinical signs of knee osteoarthritis include pain with walking, difficulty ranging the knee, knee instability, varus deformity, bony enlargement, extension lag, and flexion contracture. Radiologic evidence for osteoarthritis of the knee includes the presence of osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts, and malalignment.

Before considering total knee replacement, patients typically undergo a trial of less invasive treatments, including lifestyle modification, pharmacologic therapy, and injections. If these methods fail to produce satisfactory improvement in the patient’s symptoms, one should consider the benefits and risks of total knee replacement in conjunction with their surgeon. Outcomes following total knee replacement are excellent, with patients reporting greatly reduced pain, improved mobility, and improved quality of life. However, patients must be aware that there are serious risks that accompany any surgery, which include infection, pulmonary embolism, deep vein thrombosis, nerve damage, and need for further procedures.

PUBLISHED: Left Ureteroscopy, Stone Retrieval with Basket, and Stent Replacement

Left Ureteroscopy, Stone Retrieval with Basket, and Stent Replacement
Ahmad N. Alzubaidi, MDBlake Baer, MDTullika Garg, MD, MPH, FACS
Penn State Health Milton S. Hershey Medical Center

Urolithiasis is one of the most common and costly benign urologic conditions in the United States. While there are many options for managing urolithiasis ranging from conservative medical expulsive therapy to shockwave lithotripsy to percutaneous nephrolithotomy, ureteroscopy with laser lithotripsy is one of the most frequently performed minimally invasive urologic surgeries for treatment. In this video, we present a case of a patient with a ureteral stone that was treated with ureteroscopy, laser lithotripsy, and basket stone extraction. As part of the procedure, the patient also underwent a retrograde pyelogram and a ureteral stent exchange.

PUBLISHED: Brain Biopsy of a Suspected Cerebellar Lymphoma

Brain Biopsy of a Suspected Cerebellar Lymphoma
Martin Misch, MDPeter Vajkoczy, MDMarcus Czabanka, MD
Charite Hospital Berlin

In neurosurgery, brain biopsy is an essential tool for providing adequate histological sampling in neoplastic and non-tumorous lesions. There are two main techniques in obtaining tissue samples: open biopsy requiring craniotomy or needle biopsy. Needle biopsies allow for minimally-invasive tissue diagnosis with less risk of operative morbidity for the patient. This video article show a frameless needle biopsy of a cerebellar lesion using the Brainlab varioguide system.

PUBLISHED: Femoral Artery Cut-Down and Proximal Anastomosis Procedure (Cadaver)

Femoral Artery Cut-Down and Proximal Anastomosis Procedure (Cadaver)
Adrian Estrada1Adam Tanious, MD2Samuel Schwartz, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital

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․

PUBLISHED: Squamous Cell Carcinoma Excision from Right Forearm with Split-Thickness Skin Graft from the Thigh

Squamous Cell Carcinoma Excision from Right Forearm with Split-Thickness Skin Graft from the Thigh
Geoffrey G. Hallock, MD
Sacred Heart Campus, St. Luke’s Hospital

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.

PUBLISHED: Microsurgical Resection of an Intracranial Dural Arteriovenous Fistula

Microsurgical Resection of an Intracranial Dural Arteriovenous Fistula
Marcus Czabanka, MD
Charite Hospital Berlin

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.

PUBLISHED: Bimalleolar Ankle Fracture Open Reduction and Internal Fixation

Bimalleolar Ankle Fracture Open Reduction and Internal Fixation
Kiran J. Agarwal-Harding, MD, MPHMichael Akodu, MBBSMiles Batty, MDElyse J. Berlinberg, MDMichael McTague, MPH
Beth Israel Deaconess Medical Center

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.

PUBLISHED: Laparoscopic Heller Myotomy and Partial Fundoplication for Achalasia

Laparoscopic Heller Myotomy and Partial Fundoplication for Achalasia
Marco Fisichella, MD, MBA, FACS
VA Boston Healthcare System

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.

PUBLISHED: Bilateral Syndactyly Release of Third and Fourth Fingers

Bilateral Syndactyly Release of Third and Fourth Fingers
Sudhir B. Rao, MD1Mark N. Perlmutter, MS, MD, FICS, FAANOS2Arya S. Rao3Grant 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 Mastoidectomy with Mastoid Obliteration

Revision Canal Wall Down Mastoidectomy with Mastoid Obliteration
C. Scott Brown, MD1Prithwijit Roychowdhury2Calhoun D. Cunningham III, MD1
1Duke University Medical Center
2University of Massachusetts Medical School

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.