Randomized trial of the effect of video training on residents' surgical skills in facial skin reconstructive surgery: A SQUIRE study.

OBJECTIVES: The purpose of this study was to evaluate the impact of facial skin reconstruction training videos for head and neck and maxillofacial surgery residents. MATERIAL AND METHODS: This randomized trial, conducted in France, involved residents in head and neck and maxillofacial surgery. A website was created containing facial skin reconstruction training videos. Selected residents performed facial skin flap dissections in the Paris School of Surgery. They were randomized into two groups, one receiving a standard course before the dissection, and the other a standard course plus a video of the flap ("no-video" and "video" groups). Each resident performed 4 facial flaps and was graded (blindly) during dissection. The main study endpoint was intergroup difference in grading score (out of 15). The article was written up following the SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in EDUcation) criteria. RESULTS: Eighteen residents were included. For the main endpoint, scores were significantly higher in the "video" than the "no-video" group (6 [IQR, 4: 9] vs. 10 [9: 12]; P<0.001). In addition, as secondary endpoint, "no-video" group residents requested more assistance (3 [2: 4] vs. 1 [1: 2] P<0.001). Power was lacking for any subgroup analysis according to year of residency or to the 4 flaps. CONCLUSION: Videos improved surgical residents' performance during dissections. However, these results would be difficult to transpose to real clinical conditions. They need validating in a larger study evaluating performance in real-life procedures.

[Is ultrasound guidance contributive to vascular access in endovascular therapy?] / Intérêt de l'écho-guidage pour accès vasculaire dans la pratique de thérapies interventionnelles endoluminales.

OBJECTIVES: The aim of this study was to evaluate the contribution of ultrasound guidance (UG) to vascular puncture in endovascular therapy. Ultrasound guidance was evaluated by comparison with the rates of failures and complications of the traditional techniques of percutaneous vascular access. MATERIALS AND METHODS: We reviewed all the consecutive percutaneous revascularizations (percutaneous transluminal angioplasty and/or stenting, treatment of aneurysms and vascular traumatisms) since the standardization of the systems of closing (extra- and endovascular). The UG began in November 2011. The main objectives of the evaluation were the rate of failure of the punctures and the rate of complications (hematoma requiring transfusion or surgery for hemostasis, false aneurysm, dissection, thrombosis, infection). The failures and the complications were compared between two groups UG- and UG+. RESULTS: Between January 2008 and December 2014, 841 punctures were carried out by femoral route (85%), brachial route (12%), popliteal route (1%), axillary route (0.5%), and posterior tibial route (0.5%) with introducers between 4F and 12F. There were 20 complications (2.3%): six hematomas, four pseudo-aneurysms, three thromboses, one nervous paralysis, one stent infection, and seven percutaneous failures. The complications and the failures were significantly lower with ultrasound guidance (0.9% vs. 3.6%; P=0.02, and 0.2% vs. 1.4%; P=0.01, respectively). CONCLUSION: Ultrasound guidance makes it possible to significantly decrease the rate of complications and failures of the percutaneous accesses. This tool allowed a clear increase in the realization of the percutaneous angioplasties in outpatient hospitalization.