A guideline for femoral nerve block with the age-related formulas obtained from the distances between the femoral nerve and surface anatomical landmarks in fetal cadavers / Una guía para el bloqueo del nervio femoral con fórmulas relacionadas con la edad obtenidas a partir de las distancias entre el nervio femoral y los puntos de referencia anatómicos superficiales en cadáveres fetales

SUMMARY: The femoral nerve (FN) is used for nerve block in many surgeries and provides effective postoperative analgesics in the pediatric population. However, although there are sufficient anatomical maps and signs for femoral nerve blockades in adults, there is not enough information for the pediatric group. Therefore, in our study, we tried to determine an effective area for safe block blocking with the help of bone structures in order to perform effective blockade in younger age groups. The study was conducted on 60 lower limbs. The exit point of the FN was identified. The measurements were examined in two regards, namely the level of the FN and the relationship of the FN with the surrounding structures. For the right and left sides, all the parameters showed increases with age. A significant relationship was found between all the parameters of the fetal cadavers (p<0.01). It was determined that there was a strong correlation between all parameters related to FN and surrounding bone structures (p<0.01). Sex was not found to be significantly related to the other parameters (p<0.05 Among all the fetal cadavers, high-level division was observed in six limbs (10 %), mid-level division in 33 limbs (55 %), and lower-level division in 21 limbs (35 %). Gestational age-based regression equations from my study showed that the site of the blockage could be effectively performed with the aid of palpable bone structures from the outside without the need for technical assistance.

RESUMEN: El nervio femoral (NF) se utiliza para el bloqueo nervioso en muchas cirugías y proporciona analgesia posoperatoria eficaz en la población pediátrica. Sin embargo, aunque existen suficientes mapas anatómicos y signos de bloqueo del NF en los individuos adultos, no hay suficiente información para el grupo pediátrico. Se intentó determinar una área exacta para el bloqueo del NF junto con estructuras óseas para realizar un bloqueo efectivo. El estudio se realizó en 60 miembros inferiores. Se identificó el punto de salida del NF. Las mediciones se realizaron en dos puntos, nivel del NF y la relación de éste con las estructuras circundantes. Para los lados derecho e izquierdo, todos los parámetros mostraron incrementos con la edad. Se encontró una relación significativa entre todos los parámetros de los cadáveres fetales (p<0,01). Se determinó que existía una fuerte correlación entre todos los parámetros relacionados con el NF y las estructuras óseas circundantes (p <0,01). No se encontró que el sexo se relacionara significativamente con los otros parámetros (p<0,05 Entre todos los cadáveres fetales se observó un alto nivel de división en seis miembros (10 %), una división de nivel medio en 33 miembros (55 %) y división de nivel inferior en 21 miembros (35 %). Las ecuaciones de regresión basadas en la edad gestacional del estudio mostraron que el sitio de bloqueo se podría realizar eficazmente con la ayuda de estructuras óseas palpables desde el exterior sin necesidad de asistencia técnica.

Anatomical description of the extratemporal facial nerve under high-definition system: a microsurgical study in rats

Purpose: To describe the microsurgical anatomical aspects of the extratemporal facial nerve of Wistar rats under a high-definition video system. Methods: Ten male Wistar rats (12­15 weeks old), without veterinary diseases, weighing 220­280 g, were used in this study. All animals in this study were submitted to the same protocol and by the same surgeon. A 10-mm incision was made below the bony prominence of the right or left ear, and extended towards the angle of the mandible. The dissection was performed and the main branches of the facial nerve were dissected. Results: The main trunk of the facial nerve has a length of 0.88 ± 0.10 mm and a length of 3.81 ± 1.03 mm, measured from its emergence from the stylomastoid foramen to its bifurcation. Seven branches originating from the facial nerve were identified: posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic. Conclusions: The anatomy of the facial nerve is comparable to that of humans, with some variations. The most observed anatomical division was the distribution in posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic branches. There is no statistical difference between the thickness and distance of the structures compared to the contralateral side.

Protocol for chromosome-specific probe construction using PRINS, micromanipulation and DOP-PCR techniques

ABSTRACT Chromosome-specific probes have been widely used in molecular cytogenetics, being obtained with different methods. In this study, a reproducible protocol for construction of chromosome-specific probes is proposed which associates in situ amplification (PRINS), micromanipulation and degenerate oligonucleotide-primed PCR (DOP-PCR). Human lymphocyte cultures were used to obtain metaphases from male and female individuals. The chromosomes were amplified via PRINS, and subcentromeric fragments of the X chromosome were microdissected using microneedles coupled to a phase contrast microscope. The fragments were amplified by DOP-PCR and labeled with tetramethyl-rhodamine-5-dUTP. The probes were used in fluorescent in situ hybridization (FISH) procedure to highlight these specific regions in the metaphases. The results show one fluorescent red spot in male and two in female X chromosomes and interphase nuclei.

Modelo ex-vivo com coração bovino: proposta para treinamento de dissecção microscópica e de microanastomoses vasculares / Ex vivo model with bovine heart: a proposal for training microscopic dissection and vascularmicroanastomoses

RESUMO O treinamento é um processo que exige paciência e constante prática. A execução de procedimentos microscópicos está presente no dia a dia de diversas especialidades cirúrgicas, mas infelizmente modelos experimentais não são de fácil de acesso. Propomos um modelo com coração bovino usado por residentes e jovens cirurgiões no treinamento de dissecção microscópica e microanastomoses. É descrita a montagem deste modelo, que pode ser realizado de maneira individual e com material acessível aos departamentos cirúrgicos. Nossa experiência na elaboração das peças, assim como, dicas para o processo são descritas no texto. O modelo com miocardio bovino pode ser reproduzido em qualquer centro que disponha de bancadas e instrumental cirúrgico. Dentre as vantagens estão o baixo custo, rápido preparo e grande disponibilidade do tecido utilizado. Consideramos o projeto útil no treinamento de residentes cirúrgicos e jovens cirurgiões.

ABSTRACT Training is a process that requires patience and constant practice. The execution of microscopic procedures is present in the day-to-day of several surgical specialties, but unfortunately experimental models are not easy to access in our environment. We propose a bovine heart model used by residents and young surgeons in the training of microscopic dissection and microanastomoses. It is described the assembly of this model, which can be performed individually and with accessible material to the surgical departments. Our experience in the preparation of the pieces, as well as tips for the process, are described in the text. The bovine myocardial model can be reproduced in any center with benches and surgical instruments. Low cost, fast preparation, and wide availability of the used tissue are among the advantages of this model. We consider the project useful in the training of surgical residents and young surgeons.

Biomarkers for predicting the outcome of microdissection testicular sperm extraction for non-obstructive azoospermia patients: A systematic review / 中华男科学杂志

Infertility is a common medical condition which affects nearly 15% of the world population. Non-obstructive azoospermia (NOA) is a most challenging problem inducing male infertility and does not respond to the existing medication. Surgery is the primary method for obtaining sperm from NOA patients, but the outcome of testicular sperm extraction is unpredictable preoperatively. Recently, with the development of detection techniques for male infertility, some new biomarkers have come into notice, which may be of some value in predicting the outcome of microdissection testicular sperm extraction (MTSE) and evaluating male infertility. This article presents an overview of the known biomarkers contributive to the prediction of the outcome of MTSE for NOA patients.

Primary Glomerulonephritis with Unique C4d Deposition and Concurrent Non-infectious Intermediate Uveitis: a Case Report and Literature Review

C4 glomerulopathy is a recently introduced entity that presents with bright C4d staining and minimal or absent immunoglobulin and C3 staining. We report a case of a 62-year-old man with C4 glomerulonephritis (GN) and uveitis. He presented to the nephrology department with proteinuria and hematuria. The patient also had intermediate uveitis along with proteinuria and hematuria. A kidney biopsy that was performed in light of continuing proteinuria and hematuria showed a focal proliferative, focal sclerotic glomerulopathy pattern on light microscopy, absent staining for immunoglobulin or C3 by immunofluorescence microscopy, with bright staining for C4d on immunohistochemistry, and electron-dense deposits on electron microscopy. Consequently, C4 GN was suggested as the pathologic diagnosis. Although laser microdissection and mass spectrometry for glomerular deposit and pathologic evaluation of the retinal tissue were not performed, this is the first report of C4 GN in Korea and the first case of coexisting C4 GN and uveitis in the English literature.

Effect of testicular puncture biopsy on the success rate of microdissection testicular sperm extraction for idiopathic non-obstructive azoospermia / 北京大学学报(医学版)

OBJECTIVE@#To explore the predictive effect of testicular puncture biopsy and the biopsy results on the success rate of microdissection testicular sperm extraction (micro-TESE) in patients with idiopathic non-obstructive azoospermia.@*METHODS@#We retrospectively evaluated the micro-TESE performance in patients with idiopathic non-obstructive azoospermia (NOA) referred to the Reproductive Medicine Center of Peking University Third Hospital between January 2012 and August 2017. We discussed whether to take the testicular biopsy and testicular biopsy results, including the intraoperative microscopic examination and postoperative pathology findings, could predict the success rate of the late micro-TESE.@*RESULTS@#There were 237 patients who were diagnosed as idiopathic NOA and received micro-TESE involved in the study and the total sperm retrieve rate was 25.7%. In 103 patients without testicular biopsy and 134 patients with preoperative testicular biopsy, the sperm retrieve rate was 26.2% and 25.4%, respectively. And there was no significant difference between the two groups. The testicular volume and serum follicle stimulating hormone levels of the two groups were (4.3±1.4) mL vs.(8.5±2.4) mL and (36.1±5.2) IU/L vs.(26.1±3.5) IU/L, respectively. Compared to the patients with preoperative testicular biopsy, the group of patients without testicular biopsy had a much smaller test volume and higher serum follicle stimulating hormone and the difference between the two groups was statistically significant. For the patients who were found with a small amount of sperm in both intraoperative microscopic examination and postoperative pathological examination, the sperm retrieve rate was 100% (7/7). And for the patients who were only found with sperm in intraoperative microscopic examination or postoperative pathology examination, the sperm retrieve rate (SRR) was 47.2% (17/36). For the patients who could be not found with sperm in both intraoperative microscopic examination and postoperative pathological examination, the SRR was only 11% (10/91). The difference between the groups was statistically significant.@*CONCLUSION@#Idiopathic non-obstructive azoospermia patients with smaller testicular volume still have a chance to be found with sperm by micro-TESE. The testicular biopsy results, including intraoperative microscopic examination and postoperative pathological findings, have predictive effect on the SRR for late micro-TESE. The patient who could not be found with sperm in both intraoperative microscopic examination and postoperative pathological examination have a small chance of success in micro-TESE.

Abordaje cerrado en patología de vía aérea superior con el uso de microelectrodos: nuestra experiencia / Approach closed upper airway pathology using microelectrodes: our experience

El láser como alternativa a la cirugía abierta de la vía aérea superior ha venido a modificar la forma de abordaje de las patologías en esta área, pero no deja de ser un procedimiento costoso que no está al alcance de todos los servicios. Por este motivo se han reinventado nuevas formas de abordaje que cumplan los mismos requisitos tanto de la cirugía abierta como con láser pero con un menor coste. Presentamos una serie de 30 casos realizados en un período de 6 años por motivos tanto tumorales como no, en los que se realizaron abordajes cerrados a través de microcirugía con disección mediante microelectrodos. Obteniendo pocas complicaciones y una disminución de la estancia hospitalaria significativa. Con lo cual nos parece una técnica eficiente para abordajes de este tipo.

The laser as an alternative to open surgery of the upper airway has come to change the form of approaching the disease in this area, but it is still an expensive procedure that is not available to all services. For this reason a new ways of approach to meet the same requirements both open as laser but at a lower cost surgery. We present a series of 30 cases performed over a period of 6 years for reasons as much tumor, which closed approaches through microsurgical dissection were performed using microelectrodes. Obtaining few complications and significant decreased hospital stay. Our considerations is it seems an efficient technique for such approaches.

Micro-dissection testicular sperm extraction for patients with non-obstructive azoospermia: A report of 196 cases / 中华男科学杂志

Objective@#To investigate the effect of micro-dissection testicular sperm extraction (microTESE) for patients with non-obstructive azoospermia (NOA) and the indications of the strategy.@*METHODS@#This retrospective study included 196 cases of NOA undergoing microTESE in our center from September 2014 to March 2017. We recorded the sperm retrieval rate (SRR) and analyzed its correlation with the patients' age, testis volume, level of blood follicle-stimulating hormone (FSH), and etiological factors.@*RESULTS@#Testicular sperm were successfully retrieved from 87 (44.4%) of the patients. No significant correlation was found between the SRR and the patients' age, testis volume, or blood FSH level (P >0.05). As regards etiological factors, the SRR was 100% (29/29) in the patients with orchitis, 66.7% (16/24) in those surgically treated for cryptorchidism, 55.6% (10/18) in those with other secondary testis lesions, 60.0% (3/5) in those with AZFc deletion, 40.9% (9/22) in those with severe idiopathic testicular atrophy, 21.4% (12/56) in those with idiopathic NOA, 20.5% (8/39) in those with Klinefelter's syndrome, and 0% (0/3) in those with other abnormal karyotypes.@*CONCLUSIONS@#MicroTESE is an effective strategy for sperm retrieval in NOA patients, and the SRR is correlated with etiological factors but not with the FSH level or testis volume of the patients.

Microdissection testicular sperm extraction for patients with non-mosaic Klinefelter's syndrome: An update / 中华男科学杂志

Klinefelter's syndrome (KS) is a most frequent sex chromosomal disorder in males, which is characterized by hypogonadism and infertility. The development of assisted reproductive technology has made it possible for KS males to father children. Microdissection testicular sperm extraction (mTESE) is widely considered to be the best method for sperm retrieval in KS patients. This article presents an overview on mTESE for men with non-mosaic KS in the aspects of its predictors, sperm retrieval rate, operation procedure, preoperative hormonal therapy, and postoperative complications and testosterone reduction.

Microdissection testicular sperm extraction for patients with nonmosaic Klinefelter syndrome: A report of 143 cases / 中华男科学杂志

Objective@#To investigate the clinical application and outcomes of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS).@*METHODS@#A total of 143 nonmosaic KS patients underwent micro-TESE in the Center of Reproductive Medicine of Peking University Third Hospital between July 2012 and August 2016. We analyzed their clinical and follow-up data and evaluated the outcomes.@*RESULTS@#Spermatozoa were successfully retrieved from the testicular tissue in 44.76% (64/143) of the patients, 84.4% (54/64) by unilateral and 15.6% (10/64) by bilateral micro-TESE. Seventy-five of the KS patients were followed up in the years of 2014 and 2015. Of the 34 patients with successful sperm retrieval, 73.52% (25/34) achieved clinical pregnancy and 8 boys and 8 girls were already born in 14 of the 25 cases.@*CONCLUSIONS@#The micro-TESE is a useful method for sperm retrieval in nonmosaic KS patients, with high rates of sperm retrieval, clinical pregnancy, and birth of biological offspring.

Characteristic Changes in Decidual Gene Expression Signature in Spontaneous Term Parturition

BACKGROUND: The decidua has been implicated in the “terminal pathway” of human term parturition, which is characterized by the activation of pro-inflammatory pathways in gestational tissues. However, the transcriptomic changes in the decidua leading to terminal pathway activation have not been systematically explored. This study aimed to compare the decidual expression of developmental signaling and inflammation-related genes before and after spontaneous term labor in order to reveal their involvement in this process. METHODS: Chorioamniotic membranes were obtained from normal pregnant women who delivered at term with spontaneous labor (TIL, n = 14) or without labor (TNL, n = 15). Decidual cells were isolated from snap-frozen chorioamniotic membranes with laser microdissection. The expression of 46 genes involved in decidual development, sex steroid and prostaglandin signaling, as well as pro- and anti-inflammatory pathways, was analyzed using high-throughput quantitative real-time polymerase chain reaction (qRT-PCR). Chorioamniotic membrane sections were immunostained and then semi-quantified for five proteins, and immunoassays for three chemokines were performed on maternal plasma samples. RESULTS: The genes with the highest expression in the decidua at term gestation included insulin-like growth factor-binding protein 1 (IGFBP1), galectin-1 (LGALS1), and progestogen-associated endometrial protein (PAEP); the expression of estrogen receptor 1 (ESR1), homeobox A11 (HOXA11), interleukin 1β (IL1B), IL8, progesterone receptor membrane component 2 (PGRMC2), and prostaglandin E synthase (PTGES) was higher in TIL than in TNL cases; the expression of chemokine C-C motif ligand 2 (CCL2), CCL5, LGALS1, LGALS3, and PAEP was lower in TIL than in TNL cases; immunostaining confirmed qRT-PCR data for IL-8, CCL2, galectin-1, galectin-3, and PAEP; and no correlations between the decidual gene expression and the maternal plasma protein concentrations of CCL2, CCL5, and IL-8 were found. CONCLUSIONS: Our data suggests that with the initiation of parturition, the decidual expression of anti-inflammatory mediators decreases, while the expression of pro-inflammatory mediators and steroid receptors increases. This shift may affect downstream signaling pathways that can lead to parturition.

An Innovative Scalp-Dyeing Technique with Gentian Violet Solution During Follicular Unit Extraction for White-Haired Follicular Units

There exist some restrictions and difficulties in performing follicular unit extraction (FUE) in white-haired patients, for several reasons. In this paper, we introduce a novel technique for visualizing white hair during the punching procedure and graft preparation in FUE for white-haired patients. In white-haired older male patients, we dyed the surrounding scalp skin purple with a gentian violet solution-stained toothpick. Our method has several advantages: surgeons can easily focus on the center of the follicular unit and rapidly perform punching, they can recognize the condition of the harvested follicular units during FUE, and the hair transplant team can secure a clear view for trimming and loading into the implanter. We suggest that scalp dyeing in difficult FUE procedures, especially in patients with white hair, may be a simple method that provides a good visualization for donor site harvesting and for microdissection.

Use of Three-Dimensional Curved-Multiplanar Reconstruction Images for Sylvian Dissection in Microsurgery of Middle Cerebral Artery Aneurysms

PURPOSE: The purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction (MPR) images for sylvian dissection during microsurgical treatment of middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS: Forty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MD™ imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings. RESULTS: Utilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicular images to the sylvian surface in the same orientation as the surgeon's view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs. CONCLUSION: In addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms.

Phacoemulsification in posterior polar cataract / Facoemulsificação na catarata polar posterior

ABSTRACT Purpose: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of viscodissection and hydrodissection. Methods: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). Results: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). Conclusions: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

RESUMO Objetivo: Avaliar os resultados e complicações da cirurgia de facoemulsificação em olhos com catarata polar posterior e comparar as técnicas de viscodissecção e hidrodissecção. Métodos: Os prontuários de 29 pacientes consecutivos (16 homens, 13 mulheres) com posterior cataratas polares (44 olhos), que haviam sido submetidos a cirurgia de catarata foram analisados retrospectivamente. Os pacientes foram divididos em dois grupos de acordo com a técnica utilizada; viscodissecção foi aplicada ao grupo experimental (grupo 1) e hidrodissecção para o grupo de controle (grupo 2). Resultados: No pós-operatório, a melhor acuidade visual corrigida (BCVA) foi 0,19 ± 0,22 logMAR (média ± desvio padrão) (variação 0,00-0,70) no grupo 1 e 0,25 ± 0,18 (0,00-0,70) logMAR no grupo 2. Embora a média da BCVA pós-operatória do grupo 1 tenha sido maior do que a do grupo 2, a diferença não foi estatisticamente significativa (p=0,165). A melhor acuidade visual corrigida pós-operatória foi significativamente melhor do que no pré-operatório, em ambos os grupos (p=0,00). No grupo 1, houve ruptura capsular posterior durante a remoção do córtex em três olhos (13%); houve perda vítrea e necessidade de vitrectomia anterior mas apenas em destes olhos. No grupo 2, a ruptura da cápsula posterior ocorreu em seis olhos (28,5%); vitrectomia anterior foi necessária após a perda vítrea em três destes olhos. Embora a porcentagem de ruptura da cápsula posterior tenha sido maior no grupo 2, a diferença não foi estatisticamente significativa (p=0,207). Conclusões: As complicações em cirurgias de catarata polar posterior podem ser superadas com cautela durante toda a cirurgia e usando técnicas adequadas. Viscodissecção é melhor para evitar a posterior ruptura capsular do que hidrodissecção.

Application of microdissection testicular sperm extraction in non-obstructive azoospermia / 中华男科学杂志

The development of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) has made it possible for patients with non-obstructive azoospermia to have their own children. However, sperm retrieval by conventional TESE succeeds but in a subset of patients and, therefore, how to improve the success rate of sperm retrieval is becoming a focus of research. Recent studies suggest that microdissection TESE, although with its limitations, has obvious advantages over traditional sperm retrieval methods. This article presents an overview on the characteristics, predictive factors, sperm retrieval rate, post-operative complications, and improvement of microdissection TESE.

A Pilot Randomized Comparative Study of Two Diathermy Power Settings for Monopolar Microdissection and Bipolar Hemostasis during Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Optimal electrical power required for diathermy during tonsillectomy has not been determined. The aim of this pilot study was to evaluate and compare surgical outcomes of using diathermy power settings at 15 watts (W) and 25W for monopolar microdissection and bipolar hemostasis during tonsillectomy. SUBJECTS AND METHOD: This prospective, single-center, single-blind, randomized study was conducted on 92 patients who underwent 15W or 25W monopolar microdissection and bipolar hemostasis for tonsillectomy. Operation times, post-operative pain severities, and rates of hemorrhage were compared between the 15W and 25W groups. RESULTS: The 92 patients were randomized equally into two study groups. The mean operation duration for the 15W group was significantly longer than in the 25W group (18.5±6.11 versus 13.4±6.04 minutes, p<0.01). The rate of minimal hemorrhage (defined as an episode of bleeding not significant enough for hospital visitation) for the 15W group was significantly higher than for the 25W group (41.3% versus 20.5%, p<0.05). No significant intergroup difference was observed between the rates of primary or secondary hemorrhage or postoperative pain scores. CONCLUSION: Twenty-five watt monopolar microdissection and bipolar hemostasis for tonsillectomy had a shorter mean operation time and a lower post-operative minimal hemorrhage rate than 15W monopolar microdissection and bipolar hemostasis.

Microdissected Prefabricated Flap: An Evolution in Flap Prefabrication

When traditional flap techniques are not feasible, we apply flap prefabrication, which is more complicated and sophisticated but supplies large and thin flaps. There are some disadvantages to the technique that require improvement, such as venous congestion after flap transfer, which requires months for neoangiogenesis and necessitates a vascular carrier. Here, the author presents a new technique, called as ‘microdissected prefabricated flap,’ to successfully produce a safe, large, and thin flap. This technique is based on the microdissection of the perforators to the greatest extent possible, spreading them out into the subdermal level and using them as a carrier. The details and the application of this technique are presented and reported.