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.
Subcutaneous Ulnar Nerve Transposition
Rothman Institute at Thomas Jefferson University
Jasmine Phun
Sidney Kimmel Medical College
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.
Recipient Kidney Transplant from a Living Donor
Massachusetts General Hospital
Maggie L. Westfal, MD, MPH
General Surgery Resident
Massachusetts General Hospital
Nahel Elias, MD, FACS
Transplant Surgery Department
Massachusetts General Hospital
The patient in this case is a 56-year-old female with a past medical history of type I diabetes mellitus, hypertension, hypothyroidism, hyperlipidemia, and end stage renal disease secondary to diabetic and hypertensive nephropathies. In this video, Dr. Nahel Elias performs the recipient side of a living related kidney transplant from the patient’s sister.
Jersey Finger Repair
Rothman Institute at Thomas Jefferson University
Rachel M. Drummey, MSc
University of Central Florida College of Medicine
Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University
Jersey finger refers to an avulsion of the flexor digitorum profundus (FDP) at its insertion on the distal phalanx, the weakest point of the tendon. The injury frequently occurs during contact sports while grabbing the jersey of an opposing player as the player pulls or runs away. Surgical repair is the definitive treatment for all cases of complete rupture of the FDP tendon.
In this video article, Dr. Ilyas at the Rothman Institute demonstrates the suture anchor technique to repair a jersey finger. This approach was selected in place of the more traditional pull-out button technique for potentially stronger repair, no presence of external fixation devices, avoidance of button-related complications, and ease of rehabilitation.
Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side
Yale School of Medicine
Taylor C Brown, MD, MHS
Yale School of Medicine
Tobias Carling, MD, PhD, FACS
Yale School of Medicine
Cortical-sparing adrenalectomy allows for the resection of adrenal tumors while preserving unaffected adrenal tissue to prevent adrenal insufficiency. This is especially important in patients with bilateral adrenal tumors, typically pheochromocytomas.
Posterior retroperitoneoscopic adrenalectomy (PRA) allows for a minimally invasive approach to adrenal gland resection compared with the more traditional laparoscopic transabdominal adrenalectomy and open approaches. This approach is ideal to address patients with bilateral disease and was used in this case of a 31-year-old female patient presenting with bilateral pheochromocytomas in the setting of multiple endocrine neoplasia 2A syndrome and coexisting medullary thyroid carcinoma of the right thyroid lobe. A close review of her imaging demonstrated normal-appearing adrenal cortex tissue on the right side that allowed for cortical-sparing adrenalectomy on that side.
Airway Techniques and Equipment
UChicago Medicine
Dany Accilien, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine
Dexter C. Graves, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine
Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine
Stephen Estime, MD
Assistant Professor of Anesthesiology and Critical Care
The University of Chicago Pritzker School of Medicine
Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine
In this video, Dr. Pratt goes over airway management techniques in trauma resuscitation. It outlines the preparation and equipment used in patients with impending airway failure that require manual or mechanical ventilation. Also discussed are the innovative airway towers used in the University of Chicago emergency room as well as the general approach to airway management. The different types of laryngoscopy, assist devices, and cricothyroidotomy surgical airway procedures are also presented.
Extended Focused Assessment with Sonography for Trauma (EFAST) Exam
UChicago Medicine
Daven Patel, MD, MPH
Resident Physician
Emergency Medicine
Kristin Lewis, MD, MA
Resident Physician
Emergency Medicine
Allyson Peterson, MD
Resident Physician
Emergency Medicine
Nadim Michael Hafez, MD
Assistant Professor of Medicine
Emergency Medicine
This video covers information related to the FAST exam, which evaluates the pericardial, hepatorenal, splenorenal, and suprapubic regions for free fluid in a trauma patient as well as the extended version, which includes an additional evaluation of the pleural spaces for a pneumothorax. It goes through probe selection, probe placement and image acquisition, image optimization, and pitfalls and pearls for the subxiphoid/subcostal, right upper quadrant, left upper quadrant, suprapubic, and pleural views.
Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis
Massachusetts General Hospital
Christopher W. DiGiovanni, MD
Chief of the Foot & Ankle Service
Vice Chair for Academic Affairs
Massachusetts General Hospital
Subtalar arthrodesis is currently the mainstay treatment option for the management of recalcitrant subtalar arthrosis.
The patient in this case is a 45-year-old male who developed post-traumatic arthritis of the subtalar joint 14 years following a work-related injury in which he sustained a comminuted, joint-depression type calcaneal fracture after a 10-foot fall from a ladder. Seven years after the initial injury, imaging prompted by progressive hindfoot pain during weight-bearing or following activity revealed progressive degeneration of the subtalar joint, for which he was treated with orthoses, corticosteroid injections, and arthroscopic debridement. After exhausting both conservative and minimally invasive treatment measures at 14 years post-injury, he finally elected to undergo subtalar arthrodesis.
This video article details the methods and techniques involved in subtalar arthrodesis. After an Ollier approach was used to expose the subtalar joint, the arthritic cartilage was removed and the subchondral plate was perforated. Finally, an autogenous bone graft was harvested from the proximal tibia and inserted into the joint space, and compression was achieved by two lag screws.
Ryan A. Hankins, MD
Assistant Professor of Urology
Specialty Director of Urology
MedStar Georgetown University Hospital
The patient in this case is a 76-year-old male who was admitted to the ER two weeks prior and was found to have an obstructing, 1-cm left proximal ureteral stone with a forniceal rupture. A left ureteral stent was placed, and he was started on antibiotics. In this video, Dr. Ryan Hankins at MedStar Georgetown University Hospital performs definitive management of the stone with a left ureteroscopy, laser lithotripsy, and stent replacement.
Endoscopic Stapedectomy
Bascom Palmer Eye Institute
C. Scott Brown, MD
Neurotology & Lateral Skull Base Surgery Fellow
University of Miami Miller School of Medicine
Michael E. Hoffer, MD
Professor of Otolaryngology and Neurological Surgery
University of Miami Miller School of Medicine
Endoscopic ear surgery can improve visualization of critical structures. In this video, Dr. Scott Brown performs an endoscopic stapedectomy for the treatment of conductive hearing loss. He explains his technique and the advantages afforded by adoption of the endoscope in ear surgery.