No abstract

Dynamic infrared thermography (DIRT) has been used for the preoperative mapping of cutaneous perforators. This technique has shown a positive correlation with intraoperative findings. Our aim was to evaluate the accuracy of perforator mapping with DIRT and augmented reality using a portable projector. For this purpose, three volunteers had both of their anterolateral thighs assessed for the presence and location of cutaneous perforators using DIRT. The obtained image of these “hotspots” was projected back onto the thigh and the presence of Doppler signals within a 10-cm diameter from the midpoint between the lateral patella and the anterior superior iliac spine was assessed using a handheld Doppler device. Hotspots were identified in all six anterolateral thighs and were successfully projected onto the skin. The median number of perforators identified within the area of interest was 5 (range, 3–8) and the median time needed to identify them was 3.5 minutes (range, 3.3–4.0 minutes). Every hotspot was correlated to a Doppler sound signal. In conclusion, augmented reality can be a reliable method for transferring the location of perforators identified by DIRT onto the thigh, facilitating its assessment and yielding a reliable map of potential perforators for flap raising.

Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.

ClOVes syndrome is a rare overgrowth disorder characterized by congenital lipomatous overgrowth, vascular malformation, epidermal nevi and spinal abnormalities. Clinical aspects described by Alomari Al and sapp JC [1,2] where mostly in patients over one-year-old, whereby, the aim of our report is to describe three fatal cases of newborns with ClOVes syndrome and their clinical features.The case report is on three patients who were pre-natally diagnosed with masses in the body. All of them were born of unremarkable gestations in which there were no maternal illnesses or teratogenic agents reported. The maternal ages ranged between 23 and 35 years, and all patients were Caucasian. CaSe SerieSCase-1 A 4,400 gm girl at birth presented with a giant mass on the right side of her body that extended from the axillary region to half of the trunk and back and was associated with an overgrowth of the lower extremity and absence of toes . The skin showed several vascular stains on the thigh and flank. Magnetic Resonance Imaging (MRI) showed a combined and extensive vascular malformation with adipose tissue around it, especially in the perineum. The retroperitoneum and mesentery were also involved. epidermal nevi and scoliosis were not present. The patient had elevated D-dimer and fibrinogen levels. The vascular malformation had two episodes of sudden growth due to internal bleeding observed on ultrasound, requiring several blood transfusions (7 units of red blood cells and 14 units of frozen plasma). liver, kidney and thyroid function tests were normal. The patient had progressive respiratory distress, requiring mechanical ventilation. The child died from severe systemic Inflammatory Response syndrome (sIRs) distress at 54 days of life. Case-2A full-term, 3,808 gm boy presented with overgrowth of the left lower limb and an abnormal foot with no toes (only small buds). On his right lower extremity, he presented with macrodactyly and an increased first web space . extensive vascular stains were identified on the left lower extremity and flanks, scrotum and right toes. Angio CT imaging showed extensive retro-peritoneal and subcutaneous lymphatic malformation compromising the abdominal wall, perineum and inguinal region with increased adipose tissue and a giant venous malformation in the thighs and legs [Table/ Fig-5]. There were no epidermal nevi and scoliosis present. The coagulation analysis and D-dimer level were normal. At 26 days of age, the infant presented with poor general condition, food refusal, fever, enlargement of both lower extremities, and erythema of the left groin. He required advanced resuscitation and mechanical ventilation due to septic shock of cutaneous origin, with spontaneous drainage of purulent fluid from the lower extremity. The shock was refractory to treatment, and the infant died at 29 days of life. The pathology analysis reported gas gangrene on the left leg and foot inside hamartomatous vascular tissue. Radiology Section Case-3This patient was a full-term, 4,415 gm Caucasian girl in whom multip...

Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg. In 28 chicken legs, an anatomical study was performed. An intramuscular perforator vessel was identified and dissected. Arterial diameters of 0.7, 0.5, and 0.3 mm were identified and consistency of the perforator was assessed. In additional 10 chicken legs, 25 submillimeter arteries were anastomosed using this perforator vessel. Five arteries of 0.3 and 10 of 0.5 mm were anastomosed with nylon 11-0 and 12-0 sutures. Intravascular stent (IVaS) technique and open guide (OG) technique were used in 0.5-mm arteries. A total of 10 arteries of 0.7 mm were anastomosed using 10-0 sutures in a conventional fashion. Dissection and anastomosis time were recorded and patency was tested. We were able to identify 0.7 to 0.3 mm diameter arteries in all the specimens and confirm the consistency of the perforator. The median time for dissection was 13.4 minutes. The median time for anastomosis was 32.3 minutes for 0.3-mm arteries, 24.3 minutes for 0.5-mm arteries using IVaS, 29.5 minutes for the OG technique, and 20.9 minutes for the 0.7 mm diameter arteries. All the anastomoses were permeable. Due to its consistent and adequate diameter vessels, this model is adequate for training supermicrosurgical skills.