Until recently, anaesthetised rats have been the usual material employed for learning basic microvascular and microneurosurgical techniques. However, ethical considerations, the costs involved and legislation controlling experiments with animals allow training in microsurgery for extended periods of time at a few medical centres only. This paper reports on our experience of an alternative training programme largely conducted without using live animals. As the basic material we selected legs of slaughtered pigs. According to the developing skill of the trainee, basic microsurgical techniques can be practised on arteries and veins of various sizes in these legs. To verify positive results, the vessels are subsequently perfused with human blood under pressure. The model described is particularly suited to the acquiring of skills in microneurosurgery. Mono-, oligo- and polyfascicular nerves, structurally similar to the configurations found in human extremities, are found in pig legs. The ever-increasing importance of microsurgery in modern medicine requires more and more surgeons and orthopaedists to familiarize themselves with these techniques. The model we propose for teaching and training substantially facilitate such further professional training in an efficient way, and at the same time allows a substantial reduction in the number of experiments conducted on animals.
Pyogenic granuloma (PG) is a common skin tumour whose aetiology is unknown. There is a significant recurrence rate whatever method of treatment is used, and there are many studies in the literature on the treatment of recurrence. In our experience, the most effective way of preventing recurrence is the complete removal of the tumour using the microscope, operating in a bloodless field. Only then can the whole tumour with its supply vessels be reliably removed. 20 cases of PG on the hand, three cases in the shoulder-neck area and one case on the foot have been treated in our department over a period of 4 years. Five of these were recurrences and all involved the hand. Three of these were infected. 17 patients were followed for 3 months to 3.5 years. There were no recurrences in these patients, all of whom were operated on using the method described above.
We report an uncommon case of intermittent axillary nerve palsy caused by a humeral exostosis in an 11-year-old boy. After excision of the cartilagenous exostosis of the proximal end of the left humerus, the pre-operative symptoms of axillary nerve compression were alleviated.
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