Video-Based Microsurgical Education versus Stationary Basic Microsurgical Course: A Noninferiority Randomized Controlled Study.

BACKGROUND: Repetitive training is essential for microsurgical performance. This study aimed to compare the improvement in basic microsurgical skills using two learning methods: stationary microsurgical course with tutor supervision and self-learning based on digital instructional materials. We hypothesized that video-based training provides noninferior improvement in basic microsurgical skills. METHODS: In this prospective study, 80 participants with no prior microsurgical experience were randomly divided into two groups: the control group, trained under the supervision of a microsurgical tutor, and the intervention group, where knowledge was based on commonly available online instructional videos without tutor supervision. Three blinded expert microsurgeons evaluated the improvement in basic microsurgical skills in both groups. The evaluation included an end-to-end anastomosis test using the Ten-Point Microsurgical Anastomosis Rating Scale (MARS10) and a six-stitch test on a latex glove. Statistically significant differences between groups were identified using standard noninferiority analysis, chi-square, and t-tests. RESULTS: Seventy-seven participants completed the course. Baseline test scores did not differ significantly between groups. After the 4-day microsurgical course, both groups showed statistically significant improvement in microsurgical skills measured using the MARS10. The performed tests showed that data for self-learning using digital resources provides noninferior data for course with surpervision on the initial stage of microsurgical training (7.84; standard deviation [SD], 1.92; 95% confidence interval [CI], 7.25-8.44) to (7.72; SD, 2.09; 95% CI, 7.07-8.36). CONCLUSION: Video-based microsurgical training on its initial step provides noninferior improvement in microsurgical skills to training with a dedicated instructor.

Outcomes of Coverage of Soft Tissue Defects in the Thumb with a "Kite Flap".

Deep soft tissue injuries and defects in the digits such as pulp amputation and degloving injuries are relatively frequent in hand surgical practice. Injuries around the thumb constitute a specific subtype, because their fitting requires the use of techniques that are different from standard. Many different surgical options have been described for the treatment of these serious lesions, depending on site and size of the defect, as well as on bone exposition. The "kite flap" is one of the most popular and frequently used. Results of the treatment of 14 of the 22 patients whose defects in the thumb were fitted with the kite flap are presented. The flaps healed in all patients. At the mean follow-up of 3 years all patients declared satisfaction with the result of surgery. Most of them had slightly limited mobility of the operated thumbs but with no significant translation to the function of the hands, which was very good. The results of this study show that the kite flap is useful in reconstruction of soft tissue defects around the thumb, which are difficult to cover by more conventional techniques.

Outcomes of surgery for gouty tophi in the extremities.

<b> Introduction:</b> Gouty tophi occur in approx. 50-60% of patients suffering from gout. Their occurrence is related to severity of disease and effectiveness of treatment. They develop more frequently in patients with long lasting and poorly controlled disease.</br></br> <b>Aim:</b> The aim of the study was to evaluate the results of surgical treatment of gouty tophi of the upper and lower extremities. </br></br> <b>Materials and methods:</b> The results of surgical treatment of gouty tophi in the extremities in 14 patients, 13 men and 1 woman, at a mean age of 51 years, are presented. Twelve patients had tophi localized in the upper extremities, whereas 3 had tophi in the lower limbs (1 patient had upper and lower extremity involved). The duration of disease to the operation was a mean of 8 years. </br></br><b> Results:</b> Seven patients received excision of a single tophus, and the remaining patients had 3-15 operations performed due to multiple tophi over a period from 3 months to 2 years. The treatment outcomes were assessed at a mean of 3 years (range 2-8) after the last operation in a form of phone interview. </br></br> <b>Conclusions:</b> All patients declared satisfaction from the result of treatment. No case of complication or tumor recurrence was noted. The results confirm usefulness of surgical treatment in this form of gout.

Metastases of malignant neoplasms to the hand.

<b>Introduction:</b> Metastases of malignant neoplasms to the hand are very rare and constitute approximately 0.01% of whole distant metastases. They usually indicate generalized neoplastic disease, although sometimes can be a first manifestation of dissemination. </br></br> <b>Cases reports:</b> The study presents 4 cases of metastatic tumors to the hands in patients with diagnosis of renal (2) and lung cancer (1) and one of unknown point of origin. The lesions were localized in the fingers in two patients and in the wrist in the other two. The patient with wrist involvement received excisional biopsy of the lesion, followed by forearm amputation. Two patients with finger tumors had their affected fingers amputated. The patient with the cyst involving the wrist received local excision of the lesion. Operative wounds healed uneventfully in all patients, but 3 of them eventually died within one year from hand operation.

Hand injuries in polytrauma patients.

Hand and forearm injuries are relatively rare in polytrauma patients; their incidence is estimated at 2-5%. Hand and forearm injuries are usually not life threatening, and, therefore are considered of secondary importance, replaced by serious injuries of other body parts. However, they should be treated immediately after stabilization of the general condition of patients, as their delayed management may result in serious dysfunction of the hand. The aim of this study was to determine the incidence, distribution and methods of treatment of hand and forearm injuries in patients treated at the Polytrauma Centre of the SPSK 1 in Szczecin over the period of 4 years. Medical records of 16 patients, 11 men (65%) and 5 women (35%) with a mean age of 34 years (range 19-62) who were treated at the Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analyzed. Medical records of 16 patients, 11 men (65%) and 5 women (35%) at the mean age of 34 years (range 19-62) who were treated in Polytrauma Centre and sustained an additional injury to the hand and/or forearm were analysed. The most common component of polytrauma with associated hand injury was major bone fractures (spine, pelvis and extremities) - 12 cases (70%), followed by chest - 11 (65%), maxillofacial - 9 (53%), brain - 8 (47%) and abdominal injuries - 5 (29%). The most common injury of the distal upper limb was fracture of the distal radius - 9 patients (53%). Two patients sustained excessive crush-degloving injuries which were the primary cause of their admission to the Polytrauma Centre. Nine patients required surgery, predominantly fixation of the distal radius with a plate. All patients survived. The importance of the correct management of hand injuries performed promptly after stabilization of the general condition of polytraumatized patients was emphasized.

Microsurgical Anastomosis Rating Scale (MARS10): A Final Product Scoring System for Initial Microsurgical Training.

BACKGROUND: High cost and ethical controversy of using living models in microsurgical training made non-living models more popular. However, non-living models don't provide appropriate feedback of microsurgical performance. Currently existing Global Rating Scales used for advanced microsurgical skills validation are difficult to apply on non-living model. This study presents a simple instrument for basic assessment of microsurgical anastomosis on non-living model. METHODS: Seventy medical students were divided into 2 groups depending on their prior microsurgical experience. Each participant performed 3 end-to-end anastomoses on chicken femoral artery model. Anastomoses were reviewed by 3 blinded experts and then photographed. Evaluation included a patency tests, longitudinal cut of anastomosis, and the newly proposed tool 10 Point Microsurgical Anastomosis Rating Scale (MARS10). Presented scale consists of 5 factors important for anastomosis closure (anastomosis closure, suture spacing, bites size, knot tying, and cut ends length), graded on 3 point scale (0-2 points). Results were analyzed with analysis of variance, Spearman correlation, and t Student test. RESULTS: Anastomoses evaluated by experts as patent significantly correlated with a high summary score in MARS10 scale (r = 0.73 P < .0001). There was a significant difference in MARS10 score between groups (P < .0001). There were no significant inter-rater differences in scoring among all 3 evaluators (p > .05). CONCLUSIONS: 10 Point Microsurgical Anastomosis Rating Scale is a quick, valid, and reliable tool to assess microsurgical end-to-end arterial anastomoses on non-living model.

HISTORIQUE: Le coût élevé et la controverse éthique liés à l'utilisation de modèles vivants pendant la formation en microchirurgie ont popularisé l'utilisation des modèles non vivants. Cependant, les modèles non vivants ne donnent pas de commentaires appropriés sur l'exécution de la microchirurgie. Les échelles d'évaluation mondiales actuellement utilisées pour valider les habiletés microchirurgicales avancées sont difficiles à appliquer sur des modèles non vivants. La présente étude propose un simple instrument d'évaluation fondamentale de l'anastomose microchirurgicale sur un modèle non vivant. MÉTHODOLOGIE: Les chercheurs ont divisé 70 étudiants en médecine en deux groupes d'après leur expérience microchirurgicale. Chaque participant a effectué trois anastomoses bout à bout sur un modèle d'artère fémorale de poulet. Trois experts ont examiné les anastomoses en aveugle puis les ont photographiées. L'évaluation incluait un test de perméabilité, la coupe longitudinale de l'anastomose et la nouvelle échelle d'évaluation de l'anastomose microchirurgicale en 10 points (MARS10). Cette échelle est composée de cinq facteurs importants pour fermer l'anastomose (fermeture de l'anastomose, espace entre les sutures, dimension des piqûres d'aiguille, exécution des nœuds et longueur des extrémités de fils), classés sur une échelle de trois points (de 0 à 2). Les chercheurs ont analysé les résultats avec l'analyse de variance, la corrélation de Spearman et le test de Student. RÉSULTATS: Les anastomoses évaluées comme perméables par les experts étaient corrélées par un sommaire de cotation élevé dans l'échelle de MARS10 (r = 0,73 P < 0,0001). Il y avait une différence significative du score MARS10 entre les groupes (p < 0,0001). Il n'y avait pas de différences interévaluateur significatives dans les scores des trois évaluateurs (p > 0,05). CONCLUSIONS: L'échelle de MARS10 est un outil rapide, valide et fiable pour évaluer les anastomoses artérielles microchirurgicales bout à bout sur des modèles non vivants.