Surgery of Severe Cauliflower Ear Deformity.

A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.

A Case Report on Lateral Proboscis: A Rare Congenital Anomaly.

Lateral proboscis is a rare congenital condition characterized by a cylindrical protuberance on the nasofrontal region accompanied by abnormal nasal development on the affected side. We aimed to describe the management of the lateral proboscis in staged repair. A 7-year-old girl came with a tube-like projection on the left medial canthal region and nasal agenesis on the ipsilateral side. She was diagnosed with lateral proboscis, left microphthalmia, lower eye lid coloboma, and asymmetry in the orbital region. The patient has undergone 3 major surgeries at our institution. The first surgery involved the deconstruction of the tube to form the left nasal body and nostril. The second operation involved trimming of the new nose form and the excision of the bony protrusion directly beneath the base of the pedicle through bifrontal craniotomy. The remaining bone defect was closed using a pericranial flap. The orbital floor was reconstructed using titanium mesh. The third operation involved nasal reconstruction using a costal cartilage graft to create a dorsal nasal and alar framework. The patient healed with no complications, had become less reserved and her grades improved significantly after the operation. Further appointments are being scheduled to evaluate growth distortion and the resulting facial asymmetry. Surgical correction will be planned thereafter to further reconstruct the facial features. Evaluation of patient is necessary to explore possible clinical outcomes and corresponding treatment options. Multidisciplinary management is highly recommended, involving plastic surgeons, neurosurgeons, ophthalmologists, pediatricians, and pediatric psychiatrists in order to improve patient's quality of life.

CT-Derived 3D Printing for Coronary Artery Cannulation Simulator Design Manufacturing.

Mastering coronary angiography requires practice. Cadavers and animals do not accurately represent the human anatomical body, and practicing with actual patients has medical safety issues. Simulation offers safe and realistic conditions for cardiology intervention training. In this study, we propose a novel 3D printed simulator that contains physically realistic anatomy and has four access points. It increases safety for patients and students, and production is low-cost. We aimed to make and validate this simulator design as a prototype for coronary cannulation training. It was designed using computed tomography (CT) scan data of aorta, coronary, and heart models, and was printed by 3D printing with resin materials consisting of 75% or 85% clear resin and 25% or 15% flexible resin additive. The simulator was constructed with a camera above the simulator with a degree of LAO of 30°/0°, a display table, and an acrylic box. Twelve validators were interviewed for their expert opinions and analyzed by a qualitative method. They scored the simulator's suitability on a four-point Likert scale questionnaire. They described the simulator as having admirable values for all aspects (85.8%), curriculum suitability (92%), educational importance (94%), accuracy (83%), efficiency (78%), safety (87.5%), endurance (81.2%), aesthetics (80.7%), storage (85.4%), and affordability (85.8%).

Simulation-based training using a novel Surabaya hysterectomy mannequin following video demonstration to improve abdominal hysterectomy skills of obstetrics and gynecology residents during the COVID-19 pandemic in Indonesia: a pre- and post-intervention study.

PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic, the number of abdominal hysterectomy procedures decreased in Indonesia. The existing commercial abdominal hysterectomy simulation model is expensive and difficult to reuse. This study compared residents' abdominal hysterectomy skills after simulation-based training using the Surabaya hysterectomy mannequin following a video demonstration. METHODS: We randomized 3rd- and 4th-year obstetrics and gynecology residents to a video-based group (group 1), a simulation-based group (group 2), and a combination group (group 3). Abdominal hysterectomy skills were compared between before and after the educational intervention. The pre- and post-tests were scored by blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) and Global Rating Scale (GRS). RESULTS: A total of 33 residents were included in the pre- and post-tests. The OSATS and GRS mean differences after the intervention were higher in group 3 than in groups 1 and 2 (OSATS: 4.64 [95% CI, 2.90-6.37] vs. 2.55 [95% CI, 2.19-2.90] vs. 3.82 [95% CI, 2.41-5.22], P=0.047; GRS: 10.00 [95% CI, 7.01-12.99] vs. 5.18 [95% CI, 3.99-6.38] vs. 7.18 [95% CI, 6.11-8.26], P=0.006). The 3rd-year residents in group 3 had greater mean differences in OSATS and GRS scores than the 4th-year residents (OSATS: 5.67 [95% CI, 2.88-8.46]; GRS: 12.83 [95% CI, 8.61-17.05] vs. OSATS: 3.40 [95% CI, 0.83-5.97]; GRS: 5.67 [95% CI, 2.80-8.54]). CONCLUSION: Simulation-based training using the Surabaya hysterectomy mannequin following video demonstration can be a bridge to learning about abdominal hysterectomy for residents who had less surgical experience during the COVID-19 pandemic.

Obstetrics and gynecology residents' satisfaction and self-confidence after anal sphincter injury simulation-based workshop in Indonesia: a pre- and post-intervention comparison study.

PURPOSE: Obstetric anal sphincter injury (OASI) is one of the most common complication during delivery. Simulation models using manikin can be used as an effective medical learning method to improve students' abilities before meeting patients. It aimed to describe the development of anal sphincter injury model and assess the resident satisfaction and self-confidence after perineal repair workshop with anal sphincter injury simulator in Indonesia. METHODS: This was cross-sectional study with evaluation of outcome before and after workshop. We created silicone-latex simulation anal sphincter injury model. Then, we validated this simulation and made it as simulation model for workshop. We asked residents' satisfaction repairing anal sphincter injury using simulation model and residents' self-confidence when practicing the anal sphincter injury repair. RESULTS: All residents felt the simulation-based workshop was valuable (100%). Most of score for similarity simulation model were good (about 8). The self-assessment of confidence was measured prior to the workshop and after the workshop. The overall self-confidence was increased significantly after workshop in procedure identification external sphincter ani (EAS) (P=0.031), suturing anal mucosa (P=0.001), suturing internal sphincter ani (P=0.001), suturing external sphincter ani (EAS) (P <0.001), evaluation of sphincter ani tone (P=0.016). CONCLUSION: Anal sphincter injury simulator improves the self-confidence of residents in procedure identification external sphincter ani (EAS), suturing anal mucosa, suturing internal sphincter ani, suturing external sphincter ani (EAS) and evaluation of sphincter ani tone.