Course Review: The Griffin Institute Basic Microsurgery Workshop.

ABSTRACT: Microsurgery is an important skill for plastic and reconstructive surgeons, in addition to a number of other surgical specialties. It is one that requires a high level of surgical precision and prolonged training period with a significant learning curve. Consequently, because of the potential risk of patient morbidity, the need for high-quality simulation models is self-evident.The Griffin Institute Basic Microsurgical Workshop, in London, United Kingdom, is a 5-day practical course that uses the live rat animal training model. It provides candidates the opportunity to learn and develop microsurgical techniques through a comprehensive set of exercises with the aim of acquiring competencies before clinical practice. Here, we provide a critical evaluation of the course.

The impact of COVID-19 on dynamic hip screw fixation and training.

COVID-19 has had a profound impact on orthopaedic services and surgical training. AIM: This study aims to identify changes in lag screw position and Tip Apex Distance (TAD) in dynamic hip screw fixation due to changes in practice during the coronavirus pandemic and determine whether the changes resulted in improved patient outcomes and enhanced training opportunities. MATERIALS AND METHODS: Retrospective evaluation of two patient cohorts - pre-covid (n=27) and during covid (n=26) - to evaluate the TAD and lag screw position for each patient and record the grade of operating surgeon. A total of 53 patients were included. RESULTS: A mean TAD of 19.78mm and 19.80mm was calculated for cohort 1 and 2 respectively with no significant difference identified. When considering both key risk factors for lag screw cut-out (lag screw position and TAD) the number of patients with both a "satisfactory position" of the screw and a TAD <20mm, were 8/27 (29.6%) and 11/26 (42.3%), respectively. In cohort 1 3/27 cases had a consultant documented as the primary surgeon, while no consultants were documented as being present for the remaining 24 cases. 21/26 cases in cohort 2 had a consultant present some capacity, either as primary surgeon (15/21) or assistant (6/21). CONCLUSIONS: Changes in practice due to the pandemic have had some positive effects for both patients and trainees. This study has highlighted the importance of Consultant led trauma lists for improving training and surgical outcomes with a demonstrated improvement when considering both key factors associated with screw cut-out together. Ultimately some of the changes in practice should be continued in the post-covid era.

Reduced S100 Protein Expression in Malignant Ossifying Fibromyxoid Tumors: A Case Report.

Ossifying fibromyxoid tumor of soft parts (OFMT) is a rare mesenchymal neoplasm of uncertain lineage. OMFT normally has a benign clinical course, and malignant variants are considered unusual. Criteria defining malignancy have not yet been clearly identified and universally accepted, and there is diagnostic uncertainty between pathologists as to how best to recognize a malignant variant. We present the case of a 68-year-old male patient who, following initial diagnosis of typical OFMT in the left scapular region, presented to the sarcoma service 9 years later with a short history of a solid lesion in the right calf. Biopsy confirmed metastatic OFMT and further imaging identified three other radiologically similar but distant lesions, which were later resected. The histology of the initial biopsy was reviewed, and the original observations were found to be accurate and due to current diagnostic criteria, the specimen was reported as typical. We propose that this case report contributes to a growing body of literature suggesting that negative S100 expression may be a useful feature in identifying and characterizing malignant OFMT.