Building a microneurosurgical laboratory in Latin America: challenges and possibilities.

BACKGROUND: Training in microsurgical neuroanatomy is a priority for neurosurgical education. During the 20th century, microsurgical laboratories arose and provided a way to develop surgical skills. Few reports addressed the assembly, construction, and details of a training laboratory. METHODS: We have conducted a literature review and searched legislation on the need to plan the structure of the laboratory. RESULTS: We projected and built a laboratory through a public-private partnership. High-tech workstations and instruments were planned to meet the needs of residents, fellows, and student. All steps and materials were in accordance with the Brazilian legislation and articles previously selected. CONCLUSION: We described our experience and demonstrated the implementation of a micro neurosurgical skills laboratory.

The concept of "Four Walls, Two Poles" in the lesions of the thalamus and ganglion regions: case report and literature review.

BACKGROUND: There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. CASE PRESENTATION: Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the "Four Walls, Two Poles", lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the "Four Walls, Two Poles" has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. CONCLUSIONS: In the presented three cases the three-dimensional concept of the "Four Walls, Two Poles" allowed for safe surgical resection of lesions of the thalamus and basal ganglia.

Entrenamiento básico de microcirugía. Centro de Cirugía Experimental, Instituto de Ciencias Básicas y Preclínicas "Victoria de Girón" / Basic microsurgery training. Center for Experimental Surgery, "Victoria de Girón" Institute of Basic and Pre-Clinical Sciences

Introducción: Las técnicas microquirúrgicas son hoy enormemente aplicadas en el mundo en diferentes especialidades quirúrgicas. El centro, desde la década del 90, comenzó a impartir los entrenamientos de microcirugía vascular y nerviosa a especialistas y residentes nacionales y extranjeros respectivamente. Objetivo: Evaluar los resultados del entrenamiento de microcirugía que se imparte en el Centro de Cirugía Experimental de la Facultad de Medicina Victoria de Girón. Material y métodos: Se realizó un estudio longitudinal retrospectivo para evaluar el programa que se oferta. El entrenamiento está dividido en tres partes fundamentales: Parte teórica; prácticas en un simulador de látex; sutura termino-terminal de intestino delgado sobre la rata y, por último, el desarrollo de las técnicas básicas microquirúrgicas para un total de 90 horas. La matricula total en el período fue de 203 cursistas a quienes se les aplicó una encuesta al finalizar el entrenamiento; se midió además el tiempo de realización de la anastomosis y la permeabilidad vascular para calificarlos de Mal, Bien y Excelente al concluir. Resultados: En general fueron satisfactorios en 90 por ciento de los estudiantes sobre todo aquellos que poseen o estudian una especialidad quirúrgica, quienes presentaron mejores habilidades en un corto período que aquellos que no practicaban la cirugía reduciendo el tiempo de realización de las anastomosis y obteniendo una buena permeabilidad vascular. Conclusiones: El entrenamiento básico de microcirugía implementado constituye una útil herramienta para que los educandos desarrollen las habilidades necesarias para poder acometer con éxito las prácticas microquirúrgicas en la clínica quirúrgica(AU)

Introduction: Microsurgical techniques are currently applied in different surgical specialties worldwide. During the 90´s, our center began to implement vascular and nerve microsurgery trainings to specialists and national and foreign residents, respectively. Objective: To evaluate the results of microsurgery training that it is taught in the Center for Experimental Surgery at Victoria de Girón Institute of Basic and Pre-Clinical Sciences. Material and methods: A retrospective longitudinal study was carried out to evaluate the microsurgery training program. The training was divided into three main parts: theoretical lessons; practices upon the latex simulator; end-to-end anastomosis of small intestine on the rat; and finally, the development of basic microsurgical techniques on different vascular structures (abdominal aorta and vein) and the sciatic nerve of the rat, for a total of 90 hours of training. The total enrollment during the mentioned period was 203 students to whom a survey was applied at the end of the training; also, the time of realization of anastomosis and the vascular permeability were measured and evaluated as Bad, Good, and Excellent. Results: The results were satisfactory in general, but 90 percent of students that were carrying out their studies of a surgical specialty showed better skills in a shorter period than those that didn't practice surgery, demonstrating a less time-consuming exercise in the realization of vessel anastomosis and obtaining a good vascular permeability in this group. Conclusions: This teaching method constitutes a useful tool so that the students develop the necessary skills to carry out microsurgical practices in clinical surgery successfully(AU)

The zonal pattern of arterial supply to the brachial plexus and its clinical significance.

PURPOSE: To provide the anatomical basis of blood supply of brachial plexus for the clinical microsurgical treatment of brachial plexus injury. METHODS: Thirteen adult anticorrosive cadaveric specimens (8 males, 5 females) were dissected in this study. 3 fresh cases (2 males, 1 female) were used to observe the zonal pattern of arteries supplying brachial plexus, and 10 cases (6 males, 4 females) were used to observe the source and distribution of the brachial plexus arteries under microscope. RESULTS: The brachial plexus is supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other. According to distribution feature, blood supply of the brachial plexus could be divided into three zones. The first zone was from the nerve roots of intervertebral foramina to its proximal trunks, which was supplied by the vertebral artery and the deep cervical artery. The second zone was from the distal nerve trunks of the brachial plexus, encompassing the divisions to its proximal cords, which was supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The third zone was from the distal portion of the cords to terminal branches of the brachial plexus, which was supplied by direct branches of the axillary artery. CONCLUSIONS: The zonal pattern of arterial supply to the brachial plexus is a systematic and comprehensive modality to improve anatomical basis for the clinical microsurgical treatment for brachial plexus injury.

In situ suturing technique for severe amputation of facial composite tissues in 14 cases / 中华整形外科杂志

Objective@#To report the method and effect of in situ suturing technique for severe amputation of facial composite tissues.@*Methods@#We in situ sutured severely amputated composite tissues of facial region in 14 cases in emergency by vessels and nerves anastomosis from May 2004 to December 2017.@*Results@#All replanted composite tissues survived in 13 cases. Edge necrosis of auricle occurred in 1 case because of serious contusion and it was cured after dressing changed. The color and appearance of the replanted composite tissues were close to normal after 3 to 48 months′ follow-up.@*Conclusions@#In situ suturing technique in emergency is the ideal treatment for severe amputation of composite tissues of facial region.

The repair application of the lateral femoral cutaneous artery flap for soft tissue defects of refractory ;wounds on leg / 实用医学杂志

Objective The clinical effect of the lateral femoral cutaneous artery flap for soft tissue defects of leg wounds. Methods From October 2007 to January 2016, VSD was firstly used to promote the growth of granulation tissue. When the growth of granulation tissue became satisfactory, flaps were designed based on the anatomical characteristics of the lateral femoral cutaneous artery. We repaired 20 cases of wound defects by cutting flaps that coincide with the recipient vessels. Result 20 cases were followed up for 6 to 24 months, 12 months on average. All flaps were survived and only one case had small area of necrosis flap which was healed by replacing medicines. In all cases, wounds were healed and flaps showed good color and good texture. The strength of quadriceps muscle was good and the extension of knee flexion was 0° to 150°. Conclusion To The lateral femoral cutaneous artery flap is used for soft tissue defects of refractory wounds on leg , flap donor sites are sutured directly, the treatment period is shorten and the method is safe and effective. The lateral femoral cutaneous artery flap is one of ideal choices for wound tissue defects.

Compound flaps of foot with joint transplantation bridging severed thumbs and fingers / 中华显微外科杂志

ObjectiveTo report the methods and clinical efficacy of bridging severed thumbs and fingers with foot joint compound flaps.Methods Ten patients with completely amputated thumbs and fingers with extensive defects in the proximal phalanx had bridged and repaired by using composite-free flap with joints from foot. Three of 4 cases of thumb amputation were repaired by using composite flaps of the second metatarsophalangeal and proximal interphalangeal joints in foot,and the other was used composite flap of the second metatarsophalangeal joints in foot.Donor sites underwent the second metatarsals distal osteotomy associated with free skin graft. And 6 cases with absent fingers by using composite-free flaps of the proximal interphalangeal joint to repair. The donor site in foot underwent metatarsophalangeal and toe joints osteotomy.ResultsAll flaps and replanted thumbs and fingers survived. Hand wounds recovered by primary repair.Donor site in foot all healed by primary repair except for 1 case,which healed after several dressing changes.All 10 cases were followed-up from 6 to 28 months,averaged of 9 months.The metacarpophalangeal joint of 4 replanted thumbs extension between -10° and 0°,and flexion between 20° and 50°.The function of fullfield digital mammography recovered well in 3 replanted thumbs, as well as the function of thumb-middle in the other. Three of them could completely 2-5 fingers tapping,one case could complete middle finger tapping,four cases could complete radial abduction.The proximal interphalangeal joints of 6 replanted fingers extension between -10° and 0°,and flexion between 30° and 90°,averaged of 50°.Sensory recovery of 1 case reached S4,two cases reached S3+,five cases reached S3,and 2 cases of S2.All replanted bones and joints healed after transplantations(bone healing time was 6 to 16 weeks), with no occurrence of re-fracture nor nonunion. Walking function was not significantly affected. According to the evaluation criteria of replanted severed fingers by Chinese Medical Association,one was excellent,eight were good,and 1 was poor.The excellent and good rate was 90％. Conclusion Repairing amputated thumbs and fingers with foot joint compound flaps could not only maximize the recovery of replanted fingers shape,but also get some function,which to meet everyday needs of patients.

Experimental study on microcoagulation of dorsal root entry zone of cervical cord with bipolar forceps / 中华显微外科杂志

Objective To investigate the safety and obtain parameters of microeoagulation of dorsal root entry zone (DREZ) of cervical cord with bipolar foreps on animal model,and provide histological base for clinical application of treatment of brachial plexus avulsiol pain using microcoagulation of dorsal root entry zone.Methods On the base of swine's weight and spinal cord size in similar to human being,it was chosen to be experimental animal.The right DREZs of cervical cord were microcoagulated with bipolar forceps.The swines were fed in normal way.Their activities were observed.The mass change of the cervical cord segment were observed after 3 weeks and the cervical cord segment was fixed with 10% fromalin,paraffin sliced,HE dying.Coagulating space,depth and width were measured under microsope.The coagulating parameter were adjusted according to measuring outcome in order to achieving a most avaliable parameter.Results All post-op swine survived.When the microcogulation were made with bipolar forceps adopted following parame- ters:The distance of between the polar was 2.0 mm;The diameter of polar was 0.3 mm.The inserting depth 2 mm,the coagulated power 18 watt,the coagulated time was 2 second,then the width of lesions of DREZ in cross section was 1.15 mm and the depth of lesions was 3.10 mm,which was consistent with the area of hu- man DREZ of cervical cord.Conclusion The experiment on swine suggested,microcoagulation of DREZ by bipolar forceps is safe and no mortal complications when the testified parameters are adoped,and can achieve the area of DREZ of cervical cord in human.

Separation and reconstruction of the shared venous sinuses of craniopagus twins / 中华显微外科杂志

Objective To explore the importance of the separation and reconstruction of the shared venous sinuses of a craniopagus twins Methods The shared superior sagittal sinus, confluence of sinuses, transverse sinus and straight sinus were separated using microsurgical techniques Meantime, one bypass was established from the superior sagittal sinus and the straight sinus to the internal jugular vein with help of the bypass shunt in twin B (right) The above mentioned sinuses were reconstructed with the artificial vessels The normal superior sagittal sinus and confluence of sinuses were preserved in the twin A (left) Results Twin A recovered with no nervous deficits Unfortunately, twin B died of renal failure and hyperkalemia 22 hours after the operation Conclusion The shunt and reconstruction of the venous sinus are the key techniques for the success of separation of craniopagus twins using the microsurgical techniques

An analysis of the effect of microsurgical salpingostomy and its relevant factors / 中华显微外科杂志

Objective To report the clinical effect of microsurgical salpingostomy Methods Follow up 116 patients who used microsurgical techniques and analyzed its relevant factors,such as age,sterilization time limit,the length of the reconstructed fallopian tube,microsurgical techniques,and the site of salpingitis. Results Pursuit 116 cases,the re-pregnant rate was 86.2%(110/116). Conclusions The success of microsurgical salpingostomy depend on several factors including the length of the reconstructed fallopian tube,microsurgical techniques and the site of salpingitis.