Ulnar nerve transposition is a surgical procedure performed to treat ulnar nerve compression of the elbow, also known as cubital tunnel syndrome. This procedure is utilized after both non-operative management and in situ decompression fails, or if these procedures are deemed inappropriate based on patient pathology or ulnar nerve instability.
Transposition of the ulnar nerve involves not only decompression of the nerve but also its anterior repositioning to reduce compression and irritation while maintaining nerve integrity. This video demonstrates, on a cadaver arm, the operative technique for performing an ulnar nerve transposition using either a subcutaneous or a submuscular technique.
Sagittal band rupture leads to subluxation of the EDC tendon at the MCP joint. The common presentation involves pain and swelling at the MCP joint, visualization of extensor tendon subluxation during flexion, and inability to actively extend the MCP joint from a flexed position.
The treatment for chronic rupture, as in this case, involves surgical repair followed by six weeks in a relative motion splint, in which the injured MCP joint is placed in greater extension relative to adjacent joints. The video here demonstrates direct repair of a chronic degenerative sagittal band rupture of the right ring finger.
Cataract is a leading cause of treatable blindness in the world. The diagnosis is made through assessment of visual acuity, visual disability, and slit lamp biomicroscopy. In the US, the standard for cataract extraction has become phacoemulsification.
This article demonstrates and reviews the technique of cataract extraction using phacoemulsification with intraocular lens implantation using the divide-and-conquer technique.
Lateral Epicondylitis Debridement
Keenan R. Sobol, BS¹; Asif M. Ilyas, MD, MBA, FACS¹² ¹Sidney Kimmel Medical College at Thomas Jefferson University ²Rothman Institute at Thomas Jefferson University
Lateral epicondylitis (LE), commonly referred to as “tennis elbow,” is a common condition of the extensor tendons of the forearm that can lead to pain along the lateral epicondyle with radiation into the forearm, decreased grip strength, and difficulty lifting objects. When LE symptoms progress and can no longer be managed with non-operative measures, LE debridement may be indicated.
The approach presented here is an open debridement of the extensor carpi radialis brevis (ECRB) tendon origin. A 3–4-cm longitudinal incision was placed longitudinally over the lateral epicondyle, radial head, and capitellum. The ECRB was exposed then debrided, the lateral epicondyle was decorticated, the lateral collateral ligament was repaired, the wound was closed in layers, and a soft dressing and splint were placed.
Robotic right hemicolectomy is a minimally invasive technique for right colon resections. The technique utilizes a robotic laparoscopic instrument to perform dissection of the right colon and to perform intracorporeal anastomoses, allowing for smaller abdominal incisions, quicker recovery times, and decreased short- and long-term complications.
In this case, a robotic right hemicolectomy was performed to remove an endoscopically unresectable mass at the ileocecal valve. An intracorporeal-stapled ileocolic anastomosis was performed, and the colon was removed through a trocar insertion site. The robotic-assisted minimally invasive technique allows for clear visualization of the dissection planes and facilitates intracorporeal anastomoses that would otherwise be difficult to perform using traditional laparoscopy.
There are over 1 million hernia repairs performed annually in the US, and robotics is revolutionizing the adoption of minimally-invasive hernia repairs. From 2015 to 2018, robotic laparoscopic hernia repairs have explosively grown from less than 2% to 20% of all hernia repairs performed in the US.
Hernia repairs are among the most basic procedures for general surgeons, and there is substantial enthusiasm on the part of surgeons regarding the rapid changes in techniques as well as the best methods of teaching them. Surgical training programs may find it difficult to maintain training for their residents and fellows in the face of rapidly evolving technology. Here, Dr. Lourié presents the case of a 28-year-old male with bilateral inguinal hernias that were repaired using a robotic-assisted laparoscopic approach.
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.
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.
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.
The goal of ankle fracture management is to restore a stable and congruent joint. Operative management is recommended for most displaced fractures, fractures with dislocations, and open fractures.
This video article walks through the surgical management of a 23-year-old male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a motor vehicle collision. Dr. Weaver discusses the surgical landmarks and approaches to the ankle, the methods of fixing the malleoli and the syndesmosis, and common concerns that arise during the surgical management of ankle fractures.
