Step By Step: Microsurgical training method combining two nonliving animal models

The learning of microsurgical techniques and the maintenance of microsurgical skills have been traditionally based on the use of living animals, mainly ...

Christine M Kleintert Institute for hand and Microsurgery

Anal melanoma represents only 1% of all melanomas. Owing to delayed diagnosis and early metastasis, the prognosis is uniformly poor. Sentinel lymph node (SLN) biopsy has become the preferred method of nodal staging method for cutaneous melanoma. The role of SLN biopsy for staging of anal melanoma remains unclear. We report a 39-yr-old Caucasian woman who presented with a history of chronic hemorrhoidal pain. She noted a pedunculated peri-anal mass associated with bleeding. Upon biopsy, the lesion was found to be a 6-mm thick primary anal melanoma. There was no evidence of metastatic disease on preoperative imaging studies. She underwent wide local excision of the peri-anal site of the primary melanoma and intra-operative lymphatic mapping with both isosulfan blue and filtered technetium sulfur colloid. With the guidance a lymphoscintigram, ipsilateral inguinal sentinel lymphadenectomy identified five nodes, all of which were both "hot" and blue. One node was found to have a 1-mm metastatic deposit. Subsequently, the patient was treated with adjuvant radiation therapy to the primary site as well as to the superficial and deep inguinal nodal basins. She also received four cycles of biochemotherapy. SLN biopsy appears feasible for staging the superficial inguinal lymph nodes in patients with anal melanoma. However, the impact of SLN biopsy, early detection of occult metastasis, and adjuvant systemic and radiation therapy on the long-term survival of patients with anal melanoma is uncertain.

Sentinel lymph node metastasis in anal melanoma: a case report.

The purpose of this study is to describe the harvesting technique, anatomic variations, and clinical applications of a compound flap from the great toe and vascularized joint from the second toe used for thumb reconstruction. Five fresh cadaver dissections were studied, focusing attention on the dorsal or plantar vascular dominance, position of the communicating branch between the dorsal and plantar system, the Gilbert classification, and the size of the first dorsal metatarsal artery (FDMA) and first plantar metatarsal artery (FPMA) to the great toe and second toe. Five compound flaps were performed on five patients with traumatic thumb amputation at the level of proximal metacarpal bone. The patients' ages ranged from 14 to 47. Follow-up period was 11-24 months. The anatomic study showed that FPMA had larger caliber in 40% of dissections, FDMA in 40%, and had the same caliber in 20%. The Gilbert classification of FDMA was 40% class I and 60% class III. In the clinical applications, four patients achieved good functional opposition and motion of transferred joints with good pinch and grip strength. There was one flap failure, and donor-site morbidity was minimal. The compound flap offers advantages over traditional toe transfer by providing two functional joints. It can be used for amputation of the thumb at carpometacarpal joint level. Finally, the compound flap maintains growth potential in children through transfer of vascularized epiphyses. The disadvantages of this compound flap include a technically challenging harvest and a longer operative time.

Compound flap from the great toe and vascularized joints from the second toe for posttraumatic thumb reconstruction at the level of the proximal metacarpal bone.

Second toe-to-thumb transfer is a good alternative to using the great toe for reconstruction of the thumb. It achieves excellent function and reduces morbidity to the donor foot. However, cosmesis is often poor. The second toe has three unattractive features, a narrow "neck," a bulbous tip, and a short nail.

Aesthetic refinements in second toe-to-thumb transfer surgery.

Digital replantations are often complicated by problems of venous congestion. Conservative management is not always successful. Furthermore, the skin edge around the replanted digit is frequently inflamed and necrotic, leading to difficulties in restoring venous flow by direct venous anastomosis or interpositional vein grafts. We introduce a novel solution using the proximally based cross-finger flap. We used this flap in 10 patients who had venous congestion with inflamed, necrotic skin at their digital replant site. Their initial injuries were amputation injuries. The flap had an average length of 3.98 cm and width of 2.59 cm and was harvested from the dorsum of the adjacent, uninjured digit. There was only 1 failure, due to massive crush injury. Of the remaining 9 cases, 7 met or exceeded the sensory threshold (Semmes-Weinstein monofilament test). The 2-point discrimination test was less than 6 mm in 8 cases. Three patients complained of residual pain (based on the Michigan Hand Outcomes Questionnaire), and only 1 was unsatisfied with the appearance. The proximally based cross-finger flap is pedicled and requires only a single level of venous anastomosis distally, leading to a higher success rate. It offers a simple yet effective solution for venous congestion.

A novel solution for venous congestion following digital replantation: a proximally based cross-finger flap.

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Microsurgical training regimen with nonliving chicken models.

Programme d&#39;entra&icirc;nement MICROCHIRURGICAL avec non-humains poulet mod&egrave;les.

Mikrochirurgische Ausbildung Therapie mit leblosen Huhn Modelle.

Regime di allenamento microchirurgica con viventi di pollo modelli.

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R&eacute;gimen de entrenamiento microquir&uacute;rgica con nonliving pollo modelos.

Ligament reconstruction tendon interposition (LRTI) is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthritis. The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.

Huey Tien

Christine M Kleintert Institute for hand and Microsurgery

Step By Step: Microsurgical training method combining two nonliving animal models