In-N-Out technique: double-flanged suture ab interno iridodialysis repair.

In this study, a procedure for iridodialysis repair using an elegant, cost-effective, and quick technique using 6-0 polypropylene sutures, low-temperature electrocautery, and a 27-gauge needle is presented. Previously, all methods required performing a conjunctival peritomy to expose bare sclera and then typically intricate movements and knot tying. The method described in this study combined the sewing machine technique and a modified Yamane scleral-fixation technique to treat iridodialysis that required no knots, peritomies, or specialized equipment.

Torsion is Tolerated in Arterial End to Venous Side Anastomoses in the Rat Model.

BACKGROUND: End-to-side (ETS) anastomoses are necessary for many procedures in microvascular surgery, such as free flap transfers. In training courses that use the rat model, the arterial end to venous side (AEVS) anastomosis is a common training exercise for ETS anastomoses. Surgeons-in-training often inadvertently twist the artery when completing the AEVS anastomosis; however, in the clinical setting, torsion is a reported risk factor for ETS anastomosis failure. The purpose of this study was to determine if torsion in an AEVS anastomosis would have a negative effect on patency in the rat model, accurately simulating the clinical scenario. METHODS: All AEVS anastomoses were completed in 15 Sprague-Dawley rats divided into three torsion cohorts: 0, 90, and 180 degrees. Torsion was created in the AEVS anastomosis by mismatching the first two sutures placed between the free femoral artery end and the venotomy. Patency was verified at 0, 2, and 4 hours postoperation via the oxygenated-deoxygenated test and transit-time ultrasound blood flow measurements. RESULTS: All AEVS anastomoses were patent 0, 2, and 4 hours postoperation according to both the oxygenated-deoxygenated test and transit-time ultrasound blood flow measurements. For the average blood flow measurements at 4 hours postoperation, the proximal measurements for 0, 90, and 180 degrees were -34.3, -18.7, and -13.8 mL/min respectively, and the distal measurements were 4.48, 3.46, and 2.90 mL/min, respectively. CONCLUSION: Torsion of 180 degrees does not affect early AEVS anastomosis patency in the rat model. This contrasts with the clinical setting, where torsion is reported to cause ETS anastomosis failure. Since AEVS anastomosis torsion is often difficult to appreciate visually, we suggested that microvascular surgery training instructors include a method to both detect and prevent AEVS anastomosis torsion, such as by marking the free femoral artery end with a marking pen or suture before beginning the anastomosis.

Creation of a Rat Lower Limb Lymphedema Model.

BACKGROUND: Lymphedema is a frequent complication after surgical treatments of cancer involving lymph node resection. However, research of lymphedema treatments, such as vascularized lymph node transfer, is limited by the absence of an adequate lymphedema animal model. The purpose of this study was to determine if we could create sustainable lower limb lymphedema in the rat with a combination of inguinal lymphadenectomy, circumferential skin and subcutaneous tissue excision, and radiotherapy. METHODS: Inguinal lymphadenectomies were completed in 15 Sprague-Dawley rats. In cohort A, 5 rats received a 0.5- to 1.0-cm wide excision of proximal thigh skin and subcutaneous tissue. This step was omitted for the 10 rats in cohort B. Cohort A then received a single radiation dose of 22.7 Gy, whereas cohort B received a cumulative dose of 40.5 Gy. Bioimpedance measurements were obtained monthly to assess lymphedema progression, and lymphatic drainage at 6 months postradiation was visualized via indocyanine green (ICG) lymphangiography. RESULTS: Two rats in cohort A developed visually appreciable lymphedema in the lower limb, with bioimpedance ratios of 0.684 and 0.542 and ankle circumference ratios of 1.294 and 1.061, respectively, consistent with lymphedema. Furthermore, ICG lymphangiography in these cohort A rats revealed impaired lower limb lymphatic drainage. In cohort B, however, bioimpedance and circumference ratios, and ICG lymphangiography, did not reveal abnormal lymphatic drainage. CONCLUSIONS: The combination of inguinal lymphadenectomy, circumferential skin and subcutaneous tissue excision, and radiotherapy can successfully create lower limb lymphedema in the rat. When soft tissue excision is omitted, lymphedema does not develop.

Arthroscopic Elbow Osteocapsular Arthroplasty.

Treatment of primary elbow osteoarthritis in the young active patient less than 50 years old presents a treatment challenge to the practicing orthopaedic surgeon. Following failure of nonoperative management, surgical goals are aimed at reducing pain and improving joint mobility from bony impingement. Arthroscopic osteocapsular arthroplasty is a viable treatment option with few post-operative limitations. In contrast, total elbow arthroplasty is considered a salvage option in this patient population given the activity restrictions imposed. Osteocapsular arthroplasty combines soft tissue and bony debridement, osteophyte/loose body removal, synovectomy, capsular release, and bony contouring of the humerus and ulna to allow impingement-free range of motion.