In this case, Dr. Asif Ilyas at the Rothman Institute presents the case of an adult female presenting with a dorsally displaced and angulated fracture of the distal radius after a fall on the outstretched hand. The fracture was treated by open reduction and internal fixation with a volar locking plate, and the natural history, preoperative care, intraoperative technique, and postoperative considerations of distal radial fractures are outlined.
Epidermal inclusion cysts, also called keratin or epithelial cysts, are benign lumps that develop beneath the skin. They present as a slow-growing, painless lumps, usually with a punctum in the middle that represents the blockage of keratin excretion. Here, Dr. Lester Suntay with the World Surgical Foundation presents the case of a 64-year-old male with a mass on his upper back. It was noted to be gradually enlarging, and thus excision was performed in order to prevent further growth and infection.
Richard Hodin, MD Chief, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital
The patient in this case is a 29-year-old female who had a long history of medically refractory ulcerative colitis. Three months previously, she had undergone a laparoscopic proctocolectomy with ileoanal J-pouch reconstruction and loop ileostomy. Here, Dr. Richard Hodin at MGH reverses the ileostomy.
J. Corbin Norton Department of Urology, University of Arkansas for Medical Sciences
Amrit Singh, MD Department of Pathology, University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
Laura L. Hollenbach, MD Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences
Georgia Gamble, MD Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences
Laura A. Gonzalez-Krellwitz, MD Department of Pathology, University of Arkansas for Medical Sciences / Arkansas Children’s Hospital
Stephen J. Canon, MD Department of Pediatric Urology, Arkansas Children’s Hospital
The patient in this case is a 15-year-old female who presented with primary amenorrhea and who on work-up was found to have complete androgen insensitivity syndrome. Here, Dr. Canon at the University of Arkansas for Medical Sciences performs a prophylactic laparoscopic bilateral gonadectomy to reduce her future risk for intra-abdominal testicular malignancies. Final pathology results showed a rare case of bilateral germ cell neoplasia in situ and bilateral paratesticular leiomyomas and reinforced the decision to intervene early allowing for the removal of the gonads prior to their conversion to formal germ cell tumors.
Stenosing flexor tenosynovitis of the digital flexor tendon sheath, also known as trigger finger, occurs when there is a size mismatch between the flexor tendon and the surrounding retinacular pulley system at the first annular (A1) pulley. When the flexor tendon thickens or becomes inflamed, its ability to properly glide through the flexor tendon sheath becomes impaired. Thus, the tendon catches as the finger is flexed and extended. Conservative management includes activity modification, splinting, short-term NSAIDs, corticosteroid injection, and other adjuvant therapies. In this video, Dr. Asif Ilyas at the Rothman Institute demonstrates a surgical approach to the treatment of trigger finger via the open A1 pulley release procedure on a cadaver.
In this case, Dr. Tobias Carling and Dr. Courtney Gibson at Smilow Cancer Hospital at Yale New Haven perform a TOETVA on a 45-year-old patient who presented with a growing thyroid nodule that was shown to be a Hurthle cell neoplasm on fine-needle aspiration.
Numerous minimally-invasive approaches to thyroidectomy have been developed over the years to minimize the neck surgical scar, many of which are performed using endoscopic or robotic assistance. However, a more diminutive anterior cervical scar still remains a problem for some patients, as well as more extensive dissections for remote access operations. Therefore, natural orifice surgery was adopted at select institutions in an effort to perform a truly scarless thyroidectomy. Trans-oral endoscopic thyroidectomy has been the latest approach developed, known as the natural orifice transluminal endoscopic thyroidectomy, which is categorized as a natural orifice transluminal endoscopic surgery (NOTES) procedure. There are several ways to perform the natural orifice transluminal endoscopic thyroidectomy. Here, the authors present the TOETVA under general anesthesia.
In this case, Dr. Rockson Liu with Epic Care at Alta Bates Summit Medical Center performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
Asif M. Ilyas, MD, MBA, FACS Rothman Institute at Thomas Jefferson University
Alexander D. Selsky, BS Lake Erie College of Osteopathic Medicine
The patient in this case was a 35-year-old male who presented to the clinic with pain of the right thumb but no numbness after a fall onto an outstretched hand that resulted in a forced hyperabduction of the thumb. There was mild weakness with thumb adduction due to significant pain, but there was no evidence of median or radial nerve injury, and the radial pulses were intact. A palpable mass was identified along the medial side of the MCP, suggestive of a Stener’s lesion, and he was ultimately found to have a complete UCL tear of the right thumb.
Here, Dr. Asif Ilyas at the Rothman Institute performs a repair of the UCL with the use of a 3-0 suture anchor placed in the anatomical footprint and a temporary 0.045 K-wire placed across the MCP joint for reinforcement.
Preview of the case: https://www.youtube.com/watch?v=JxdoYtjgZBE&ab_channel=JOMI-JournalofMedicalInsight
Ajaipal S. Kang, MD Cosmetic, Plastic & Reconstructive Surgery Specialist UPMC Hamot
In this case, Dr. Ajaipal Kang at UPMC Hamot performs a bilobed nasolabial flap and a rhomboid flap to close a left nasal ala defect that remained following an excision of a basal cell cancer.
Asif M. Ilyas, MD, MBA, FACS Rothman Institute at Thomas Jefferson University
In this case, Dr. Ilyas at the Rothman Institute performs a subcutaneous anterior transposition on a patient with cubital tunnel syndrome. The patient’s ulnar nerve subluxed upon elbow flexion and extension upon physical examination, which was a primary indication for choosing this surgical approach over other techniques.
This procedure not only decompresses the affected nerve but also transposes the nerve anterior to the medial epicondyle so as to relieve strain on the nerve upon the full range of motion of the elbow.
