Microsurgery
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The purpose of this study was to describe microsurgical anatomy of the dorsal root entry zone (DREZ) and provide an anatomic basis for the approach of DREZ lesion in treating radiculopathy of brachial plexus avulsion injuries. We studied 100 dorsal cervical roots and DREZ/posterior horn complexes in 20 adult cadavers. At each root level the following data were recorded: widths of laminectomy, numbers of posterior rootlets, angle of the inferior rootlets with the spinal cord, and distance from posterior median sulcus to posterolateral sulcus. ⋯ The average length, width, and angle of posterior horn were 3.47 mm, 1.346 mm, and 35.9 degrees , respectively. Our study demonstrated that the spinous process and lamina of the C4 to C7 vertebrae should be resected to expose the C5-T1 when DREZ lesions are employed to treat pain after brachial plexus avulsion. The lesion-making apparatus should be inserted at an angle of 30 degrees -40 degrees , the width of lesion should be less than 1.2 mm and the lesion depth less than 3.1 mm.
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Although direct exposure to procedures in the operating theater environment, together with practice on laboratory animals, is still seen as the gold standard of teaching in microsurgery, practice on nonliving simulators is currently being validated as an important educational tool. We reviewed the widely used nonliving training models, together with currently accepted innovations, which are parts of curricula of training courses in microsurgery. Using the experience accumulated in training programs at the Centre for Simulation and Training in Surgery, we identified which particular skills can be reliably targeted by each nonliving tissue exercise. ⋯ The training program can comprise a series of increasingly difficult exercises, which mirror the real life situations. Performance on nonliving models in each progressively more challenging exercise can be assessed via direct observation, assisted by clear and objective criteria. Finally, focused training will help both the transition to human surgery and replication of the favorable results to large series of subjects.
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Preoperative imaging is sought prior to DIEA (Deep Inferior Epigastric Artery) perforator flaps due to the potential for maximizing operative success and minimizing operative complications. Recent advances include the use of computed tomography (CT) angiography (CTA) and magnetic resonance angiography. Image-guided stereotactic surgery is a recent technique that has been used with success in several fields of surgery. ⋯ Stereotactic navigation demonstrated a slightly better (nonsignificant) correlation with perforator location than conventional CTA. As such, CT-guided stereotactic imaging is an accurate method for the preoperative planning of DIEA perforator flaps, providing additional and potentially more accurate data to conventional CTA. With no additional scanning required, the method described in this paper allows the combined use of both methods for preoperative planning.
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The incidence of obstetric brachial plexus palsy is not declining. Heavy birth weight of the infant and breech delivery are considered two important risk factors and Caesarean section delivery seems to be a protective factor. ⋯ Surgical intervention is needed for 20-25% of all patients and clinical information is decisive for the indication of surgery. Most often, a conducting neuroma of the upper trunk is encountered, and it is believed that neuroma resection followed by microsurgical reconstruction of the brachial plexus gives the best results.
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Neurosurgeons need fine and special microsurgical techniques, such as the ability to suture deep microvasculature. Intensive training is required to perform microsurgery, especially in deep microvascular anastomosis. ⋯ Here, we report a new training method using a mannequin head, water balloons, and clay to mimic actual deep microsurgery in the brain. This method allows trainees to experience microsurgery under various hand positions to approach the affected areas located at various depths in the brain from various angles.