Tag Archives: open

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Debridement and External Fixation for Bilateral Neglected Open Tibial Shaft Fractures

Debridement and External Fixation for Bilateral Neglected Open Tibial Shaft Fractures
Donald L. Fejfar, MD1; Nikhil Gattu, MD1; Ridwan M. Saeed, MD2; Hizkyas Kassaye, MD3; Bitiel Banda, MD4; Pierre M. Woolley, MD5; Kiran J. Agarwal-Harding, MD, MPH1,6
1Harvard Global Orthopaedics Collaborative, Boston, MA
2Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
3Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
4Mzuzu Central Hospital, Mzuzu, Malawi
5Hôpital Universitaire La Paix, Port au Prince, Haiti
6Beth Israel Deaconess Medical Center, Boston, MA

Open tibial shaft fractures represent a significant clinical challenge, particularly when presentation is delayed and wounds have become infected. This case demonstrates the surgical management of bilateral neglected open tibial shaft fractures in a young adult male who presented three weeks after initial injury from a motor vehicle collision in rural Malawi. He also suffered a bimalleolar fracture of the left ankle. The patient had grossly contaminated wounds with exposed bone and signs of infection bilaterally. The key procedural steps included aggressive irrigation and debridement of necrotic and infected tissue, skeletal stabilization with external fixation, local antibiotic therapy with gentamicin-impregnated collagen pellets, and soft tissue coverage with primary wound closure and a rotational subcutaneous flap on the left leg. External fixation is an essential treatment modality for open fractures with severe soft tissue injury when internal fracture fixation is not possible, especially in delayed cases with early signs of infection. This allows for staged management, repeated wound access, and preservation of blood supply while providing adequate stability for bone healing and soft tissue rest. This technique is particularly valuable in resource-limited settings where staged reconstruction and damage control orthopaedics are essential. The bilateral nature of these injuries, prolonged contamination period, immunocompromised status, and need for complex soft tissue reconstruction make this case unique and highlight the principles of managing neglected open fractures in challenging clinical circumstances.

General Surgery, Print Release

PUBLISHED: Single-Port Hybrid Open and Laparoscopic Approach for Pediatric Appendectomy for Acute Appendicitis

Single-Port Hybrid Open and Laparoscopic Approach for Pediatric Appendectomy for Acute Appendicitis
Yuki Noguchi, MD, PhD; Shogo Saito, MD; Shohei Hiwatashi, MD, PhD; Satoshi Umeda, MD, PhD; Masahiro Zenitani, MD, PhD; Keigo Nara, MD, PhD
Osaka Women’s and Children’s Hospital

Acute appendicitis is one of the most common surgical conditions in pediatric patients, and laparoscopic appendectomy is widely accepted as the standard treatment. However, conventional multi-port laparoscopic techniques and intracorporeal single-port approaches can be technically demanding in children due to the limited intra-abdominal working space and instrument interference.

This case involved a 4-year 9-month-old girl presenting with acute abdominal pain and vomiting. Ultrasonography demonstrated appendiceal enlargement with suspected appendicolith, supporting the diagnosis of acute appendicitis and indicating a potential risk of progression and recurrence.

To address both anatomical and technical considerations, a hybrid laparoscopic–open appendectomy using a single umbilical incision was adopted. A small longitudinal incision was made at the umbilicus, and a wound protector with a multiport cap was applied. Adequate exposure was confirmed when the surgeon could insert an index finger into the abdominal cavity. The laparoscopic component was limited to identifying and grasping the appendix, which was then retracted and exteriorized through the umbilical incision. Appendectomy was performed extracorporeally under direct visualization, thereby avoiding technically demanding intracorporeal maneuvers. In this case, the degree of inflammation was mild, allowing smooth mobilization and uncomplicated extracorporeal removal.

This hybrid approach simplifies the procedure while preserving the advantages of minimally invasive surgery, including reduced operative complexity and improved cosmetic outcomes, and represents a practical option for pediatric appendicitis.

Print Release, Surgical Technology

PUBLISHED: Setup for an Open Pancreatectomy (Kingsborough Community College, Brooklyn, NY)

Setup for an Open Pancreatectomy (Kingsborough Community College, Brooklyn, NY)
Gina Forsythe, CST
Kingsborough Community College, Brooklyn, NY

Open pancreatectomy is a complex abdominal procedure requiring detailed preoperative preparation by the surgical technologist. An efficient sterile back table and Mayo stand setup is important for patient safety and operative workflow. In this educational video, the setup sequence demonstrates sterility verification, instrument organization, the initial surgical count, and medication labeling. All steps were conducted in accordance with perioperative safety standards.

General Surgery, Global Surgery, Print Release

PUBLISHED: Open Cholecystectomy for Gallbladder Disease

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.

General Surgery, Global Surgery, Print Release

PUBLISHED: Open Cholecystectomy for Gallstone Disease

Open Cholecystectomy for Gallstone Disease
Liborio “Jun” Soledad, MD; Enrico Jayma, MD; Ted Carpio, MD
World Surgical Foundation

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.

Announcement, General Surgery, Preprint Release

PREPRINT RELEASE: Open Lobectomy

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Open Lobectomy
Massachusetts General Hospital
Christopher R. Morse, M.D.
Assistant Professor of Surgery, Harvard Medical School
Co-Director, Gastroesophageal Surgery Program

An adult male with cystic fibrosis (CF) presents with a chronically damaged left upper lung lobe that Dr. Christopher Morse decides to treat with an open lobectomy given that the patient was not going to heal from antibiotic therapy and still had mild preserved pulmonary function. Two unusual things in this procedure are the dense inflammatory changes at the hilum and the use of muscle from chest wall to reinforce the bronchial closure because of the patient’s recurrent and chronic pulmonary infections due to CF.
Announcement, General Surgery, Preprint Release

PREPRINT RELEASE: Distal Gastrectomy (Open)

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Distal Gastrectomy (Open)
John T. Mullen, MD
Director, General Surgery Resident Program
Massachusetts General Hospital

 

An 80-year-old patient with anemia undergoes an upper endoscopy that reveals inflammation in the distal stomach. Biopsies identify it as an early intramucosal adenocarcinoma while an endoscopic ultrasound shows the tumor invading the muscle of the stomach. Given that there are no signs of metastasis, the patient presents for a potentially curative gastrectomy where Dr. John Mullen removes the distal two-thirds of the stomach, performs a D1 lymph node dissection and a partial D2 lymph node dissection, and reconstructs in a Billroth II fashion.
General Surgery, Preprint Release, Vascular Surgery

PREPRINT RELEASE: Thoracoabdominal Aortic Aneurysm Repair – Part 2

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0109b-screenshotThoracoabdominal Aortic Aneurysm Repair – Part 2
Virendra I. Patel, MD, MPH
Associate Program Director, General Surgery Residency; Department of Vascular and Endovascular Surgery
Massachusetts General Hospital

Dr. Patel continues repairs on this thoracoabdominal aortic aneurysm in Part 2 of this two part series. Watch as he works against the clock during visceral ischemia time until blood flow from the graft is restored to all the dependent organs! (Pre-print, Part 2 of 2).

This article follows a previously released Part 1.

General Surgery, Preprint Release, Vascular Surgery

PREPRINT RELEASE: Thoracoabdominal Aortic Aneurysm Repair – Part 1

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0109AThoracoabdominal Aortic Aneurysm Repair – Part 1
Virendra I. Patel, MD, MPH
Associate Program Director, General Surgery Residency; Department of Vascular and Endovascular Surgery, Massachusetts General Hospital

Watch Dr. Patel as he performs a Type 1 thoracoabdominal aortic aneurysm repair with distal aortic perfusion through an atriofemoral bypass circuit. (Pre-print, Part 1 of 2).