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.
Occasionally, the treatment of breast cancer requires the removal of the breast while also leaving a large chest skin deficit. Especially if radiation has been done or is planned, the best way to restore the missing skin to preserve its essential function would be by the use of a vascularized flap. Sometimes this can be achieved while simultaneously providing a reconstruction of a very aesthetic breast mound. Depending on circumstances and the extent of disease, a simpler solution might be to just close only the chest wound that has been created.
A “workhorse” flap alternative that is almost always available to achieve this is the latissimus dorsi (LD) muscle from the back, as this can be moved to almost all regions of the chest. The LD muscle usually can be swung to the chest about its blood vessels that remain attached to the armpit, and so would be called a local flap that as such avoids the complexities of a transfer requiring microsurgery to reconnect the blood supply. The long-term experience by reconstructive surgeons in using the LD muscle as a local flap, not just for the chest but also the back, head, and neck, has proven its deserved accolade to be a versatile flap unparalleled by most other donor sites.
Aspiration of Ganglion Cyst on Right Wrist Jonathan E. Sledd1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2 1Edward Via College of Osteopathic Medicine – Auburn Campus 2Philippine Children’s Medical Center
Ganglion cysts are sacs containing a gel-like fluid that can form over tendons and joints. They are commonly seen as visible lumps on the hand and back of the wrist. Ganglion cysts are not cancerous, and most are asymptomatic. But if a cyst puts pressure on a nerve, it can cause pain, tingling, and muscle weakness. Initial treatment of a ganglion cyst is not surgical. Observation may be recommended because half of ganglion cysts may disappear over time. Activity often causes the cyst to increase in size, and thus immobilization may be an option. If a ganglion cyst causes pain and limits activities, aspiration of the fluid may decrease pressure and relieve pain. Surgical excision may also be recommended if symptoms are not relieved or if the cyst recurs. This article presents the case of a 51-year-old female who had a ganglion cyst on her right wrist. Treatment options were presented to the patient, and she opted to undergo aspiration over excision.
Open Proctocolectomy for Hirschsprung’s Disease Mudassir Shah Akhter, MD1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2 1Oregon Health and Science University 2Philippine Children’s Medical Center
Hirschsprung’s disease is the main genetic cause of functional intestinal obstruction. Most cases are diagnosed in the first few months of life given classical presentation and ease of testing with rectal suction biopsy. The disease is due to the absence of enteric ganglion cells in the distal colon that results in functional constipation. Resection of the affected segment and bringing the normal bowel close to the anus has been the mainstay of treatment. Due to advances in surgical treatment over the past decades, a significant reduction in morbidity and mortality has been observed, and the previously multistage procedure can now be completed in one stage, as presented here.
Central venous access is a crucial aspect in the management of patients requiring long-term therapies, particularly surgical patients. These therapies include the administration of therapeutic agents, fluid administration, antibiotic therapy, parenteral nutrition, etc. The procedure involves the placement of a catheter into a venous great vessel. Three main sites for central venous access are: internal jugular vein, common femoral vein, and subclavian veins.
In resource-constrained settings, healthcare professionals must rely on their clinical practice and proficiency in performing procedures without the aid of advanced imaging modalities. One such procedure is the infraclavicular subclavian vein cannulation, which can be performed without ultrasonographic guidance, providing a reliable means of obtaining central venous access. Here, this is demonstrated on a pediatric preoperative patient during a surgical mission in Honduras.
Drainage of Cystic Mass on First Left Toe Jasmine Beloy1; Jaymie Ang Henry, MD, MPH2; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES3 1Lake Erie College of Osteopathic Medicine 2Florida Atlantic University 2Philippine Children’s Medical Center
Cutaneous cysts are closed, sac-like, or encapsulated structures that may be filled with air, liquid, or semi-solid material, and are generally benign. Many types of cysts can occur in almost any place throughout the body and can form in all ages. They are seen as slow-growing and painless lumps underneath the skin. However, some cysts may be painful if they are particularly large. Treatment depends on several factors including the type of cyst, location, size, and the degree of discomfort caused. Large, symptomatic cysts can be removed surgically, while smaller, asymptomatic cysts can be drained or aspirated. Here, we present the case of a 12-year-old male with a pus-filled cystic mass on his first left toe and discuss surgical management and follow-up.
Maintenance of intact skin throughout the body is essential to prevent dehydration, to act as a barrier to infection, to allow unrestricted movement, and to provide a normal appearance. A flap is a piece of body tissue, usually skin and fat, that always has its own blood supply. Therefore, a flap can be moved anywhere it can reach without worrying about the circulation present at the place that needs it, which is called the recipient site. When compared with all other possible choices, a flap best meets all the requirements for any area needing skin replacement.
The keystone type flap as one such option is so named because its design has the shape of the keystone of a Roman arch. If taken from loose tissues adjacent to a defect, it can be simply cut and advanced for any necessary skin coverage. Direct closure of the donor site where this flap comes from is possible so that usually a quite good overall cosmetic result is also obtained. These virtues are shown as an overview in this video where a keystone flap is transferred after removal of a common basal cell skin cancer from the lower lip.
Bone Graft for Nonunion of Right Thumb Proximal Phalanx Fracture Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3; Grant Darner4 1Big Rapids Orthopaedics 2Carolina Regional Orthopaedics 3Columbia University 4Duke University School of Medicine
In this video, the authors describe and demonstrate a surgical technique for the treatment of an unstable nonunion of a proximal phalangeal fracture of the thumb.
The video describes the surgical exposure, preparation of the nonunion site, harvesting of autogenous iliac corticocancellous bone graft, bone grafting of the defect, and stabilization with K-wire fixation.
Open Cholecystectomy for Gallbladder Disease Jacob C. Mesiti1; Yoko Young Sang, MD2; Peter F. Rovito, MD2; 1Lake Erie College of Osteopathic Medicine 2World Surgical Foundation
Gallbladder diseases are a subset of a spectrum of pathologies of the biliary system and are a particularly common etiology of abdominal pain encountered in modern medicine. These pathologies most often share a similar underlying mechanism of disease: obstruction of a portion of the biliary tree by cholelithiasis, or gallstones.
Gallstones, for the most part, form initially in the gallbladder with the exception of primary common bile duct (CBD) stones that form primarily in the CBD. Risk factors include a wide variety of conditions both pathologic and physiologic, including hyperlipidemia, hemolysis, and pregnancy. The resulting obstruction creates a state of biliary stasis, eventually leading to inflammation, pain, and an increased risk of infection. The anatomical location of the obstruction contributes greatly to both the clinical presentation and the ultimate treatment of the disease.
A hallmark of the treatment of gallbladder disease, ranging from simple biliary colic to life-threatening emphysematous cholecystitis, is the cholecystectomy. In modernized countries, this procedure is almost invariably performed laparoscopically. However, in certain clinical scenarios, such as when a patient cannot tolerate the pneumoperitoneum associated with laparoscopic surgery or when the procedure takes place in a developing country with limited access to laparoscopic capabilities, an open approach is preferred.
Gallstone disease is one of the most common disorders affecting the digestive tract. Most individuals with gallstones are asymptomatic and do not require treatment. For symptomatic patients, however, cholecystectomy is recommended.
Cholecystectomy is one of the most common abdominal surgeries performed worldwide. Indications include moderate-to-severe symptoms, stones obstructing the bile duct, gallbladder inflammation, large gallbladder polyps, and pancreatic inflammation due to gallstones.
Here, we report the case of a 53-year-old male with stones in his biliary duct. Despite having uncomplicated disease, the patient was treated with a primary open cholecystectomy because laparoscopy was not available.
