Accuracy of Mirror Image Mapping of Lymphatic Tract for High-stage and Reoperative Lymphaticovenular Anastomosis: Intraoperative Analysis and Early Clinical Outcome.

Background: Indocyanine green lymphography (ICGL) generally has a nonlinear pattern in advanced-stage lymphedema. Despite the lack of a linear pattern ICGL, lymphatic vessels have been discovered in several studies. The purpose of this work was to establish lymphatic mapping utilizing information from the contralateral limb and to illustrate the symmetry of lymphatic systems. Methods: Data were retrospectively collected from 81 patients who underwent lymphaticovenular anastomosis (LVA) using the contralateral mapping technique during 2018 to 2022. The sensitivity, specificity, accuracy, and negative and positive predictive values of this technique were calculated and analyzed. Results: Lymphatic vessels were identified in 85.2% of the upper and 82.3% of the lower limb presumed sites using the contralateral mapping technique. The positive predictive value for successful LVA anastomosis was 93.8% for upper limb and 92.3% for lower limb cases. This mirror image technique's accuracy was 91.7% and 91.1%, for the upper limb and lower limb group, respectively. Between reoperative and new LVA cases, there was no statistically significant difference in the number, type, or diameter of lymphatic vessels or number of anastomoses. Conclusions: LVA with contralateral mapping technique is an effective method for patients with high-stage lymphedema with a nonlinear pattern on ICGL.

Utilization of images and three-dimensional custom-made nostril retainer fabricate for patients with cleft lip and cleft lip nose deformities at Siriraj Hospital: preliminary phase.

A prospective study utilizing image analysis to assess nostril openings in post-operative patients with cleft lip and cleft lip nose deformities. This preliminary study seeks to employ two-dimensional (2D) images to fabricate a custom-made nostril retainer. This study was performed at Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. This study included 30 healthy volunteers and 15 patients with cleft lip and cleft lip nose deformities. The nostril opening width and height for all participants were measured, and photographs were taken. An image analysis application was used to fabricate a three-dimensional (3D) custom-made nostril retainer. The mean differences between the direct measurements of the nostril aperture and the measurements obtained through the program did not exceed 2 mm in terms of nostril height, width, or columella. Two-dimensional photographs can be used to create a custom-made, three-dimensional nostril retainer. This retainer allows post-operative patients to maintain their nares without needing to visit the hospital, thereby reducing the cost of care.

Radiological landmark of syndesmotic ligament complex by magnetic resonance imaging correlate with fibula free flap harvesting procedure.

Preservation of syndesmotic ligaments is crucial for preventing adverse sequelae at the donor site following free fibula osteocutaneous flap harvesting. This study sought to determine the relationship between distal tibiofibular ligaments and the fibular segment to identify radiological landmarks that facilitate safe and precise flap. The distances between the distal tibiofibular ligaments (anterior inferior tibiofibular ligament [AITFL], posterior inferior tibiofibular ligament [PITFL]) and the fibular segment, as well as the lower border of the interosseous membrane, were measured on magnetic resonance imaging (MRI) scans of 296 patients without any perceivable ankle abnormalities. The mean distances (± SD) between the distal end of the fibula and the AITFL, PITFL, and lower interosseous membrane border were 3.0 ± 0.4 cm, 2.6 ± 0.4 cm, and 3.9 ± 0.6 cm, respectively. The distance between the talar dome and the PITFL exhibited a range of 0.0-0.5 cm. Our findings support preserving a distal fibular remnant of at least 4 cm to avoid injury to the syndesmotic ligament throughout fibula osteocutaneous flap harvesting. The talar dome could serve as a useful radiological landmark for identifying the upper border of PITFL during preoperative evaluation, and thus facilitating precise and safe flap procurement.

The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps.

Computer-assisted surgery (CAS) has been introduced to mandible reconstruction with fibular-free flap in cutting guide placement. When CAS cooperates with different plate fixations, the results show various degrees of errors by which this study aimed to evaluate. Mock surgeries were conducted in 3D-printed mandibles with 2 types of defects, limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of fixations, miniplate, manually bending reconstruction plate, and patient-specific plate, are tested, each of which was performed 3 times in each type of defect, adding up to 18 surgeries. One with the least errors was selected and applied to patients whose 3D-printed mandibles were derived. Finally, in vivo errors were compared with the mock. In limited defect, average errors show no statistical significance among all types. In extensive defect, patient-specific plate had a significantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively). When patient-specific plate was applied in vivo , the errors were not significantly different from the mock. Patient-specific plates that cooperated with CAS showed the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.

Surgical Anatomy for Fibular Free Flap Focusing on the Inferior Tibiofibular Syndesmotic System: A Cadaveric Study and Case Series of 3-Dimensional Prefabricate Cutting Guided Fibular Free Flap.

ABSTRACT: Even though there are many options for mandibular reconstruction, a free fibula osteocutaneous flap is regarded as the most frequently used flap. Despite having some previous anatomical studies pertaining to syndesmotic ligaments, there is no study pointing out that surgical landmarks can be used while free fibula osteocutaneous flaps are performed and used for surgical landmarks in order to avoid syndesmotic ligament injuries. Therefore, this study investigates the characteristics and relationship between inferior syndesmotic ligaments and fibula in cadavers. A total of 140 legs were obtained from 83 embalmed cadavers as well as other soft ones, which were donated for the inferior tibiofibular syndes- motic system's study. Detailed dissection and measurement of each ligament's distance to the end of the fibula and lateral malleolus were performed. Distances from the distal end of the fibula to anterior inferior tibiofibular ligament, posterior inferior tibiofibular, and inferior transverse ligament, and the lower border of the interosseous membrane are 3.5 ±â€Š0.4 cm, 3.4 ±â€Š0.5 cm, 1.9 ±â€Š0.4 cm, and 5 ±â€Š1 cm (mean ±â€ŠSD), respectively. Distance from the most distal part of the fibula to lateral malleolus is 1.6 ±â€Š0.4 cm (mean ±â€ŠSD). Thus, the remaining distance of the fibular should be left at least 4 cm without disrupting the syndesmotic ligament complex. It is argued that the lateral malleolus can be applied as a surgical landmark while harvesting fibula.

Precision of Low-Cost Augmented Reality in Prefabricated Cutting Guide for Fibular Free Flap Surgery.

BACKGROUND: Augmented reality (AR) is an imaging technology encompassing an interactive experience of a real-world environment enhanced by computer-generated perceptual information. It has been introduced to current medical practice to help the preoperative planning in many surgical fields. METHODS: The authors applied AR to the computed tomography angiography of 8 patient's legs. Computed tomography angiography images were processed into Digital Imaging and communications in Medicine files to make a prefabricated cutting guide and customized titanium plate. Also, three-dimensional reconstruction of the arterial supply of the leg was performed to identify the perforators. RESULTS: Followed by preoperative marking of operative details on patient's skins in antero-posterior view, lateral view, and combination of both views. Inaccuracy of measurement was confirmed by duplex ultrasound which average error of the combination of antero-posterior and lateral viewed of both legs was lowest (0.7 ± 0.2 cm). Followed by lateral view (1.0 ±â€Š0.3 cm) and antero-posterior view (1.2 ±â€Š0.4 cm), respectively. CONCLUSIONS: Augmented reality can improve patient's safety by directly locate the perforator and easily to design the skin paddle. Followed by satisfaction and confidence in patients and their relatives. Augmented reality also promoted understanding of operative steps for related assistants, residents, or fellows. Augmented reality can perform with existing equipment, mobile phone application, and can save the cost for preoperative planning. Distortion in the depth view can be more accurate by combining of AR in antero-posterior and lateral view.