Lymphatic patterns in the superficial circumflex iliac artery perforator flap.

BACKGROUND: Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer (LIFT) technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the superficial circumflex iliac artery perforator flap. METHODS: This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24-minutes after indocyanine green lymphography (ICG) injection. Standardized procedures were implemented for all participants in both hospitals. RESULTS: The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the superficial circumflex iliac artery perforator flap were oriented towards the inguinal lymph node. However, the left SCIP zone lymphatic vessels were directed opposite to the inguinal lymph node. CONCLUSION: The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was towards the inguinal lymph node, although only single side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.

Ocular Drug Delivery: A Special Focus on the Thermosensitive Approach.

The bioavailability of ophthalmic therapeutics is reduced because of the presence of physiological barriers whose primary function is to hinder the entry of exogenous agents, therefore also decreasing the bioavailability of locally administered drugs. Consequently, repeated ocular administrations are required. Hence, the development of drug delivery systems that ensure suitable drug concentration for prolonged times in different ocular tissues is certainly of great importance. This objective can be partially achieved using thermosensitive drug delivery systems that, owing to their ability of changing their state in response to temperature variations, from room to body temperature, may increase drug bioavailability. In the case of topical instillation, in situ forming gels increase pre-corneal drug residence time as a consequence of their enhanced adhesion to the corneal surface. Otherwise, in the case of intraocular and periocular, i.e., subconjunctival, retrobulbar, peribulbar administration, among others, they have the undoubted advantage of being easily injectable and, owing to their sudden thickening at body temperature, have the ability to form an in situ drug reservoir. As a result, the frequency of administration can be reduced, also favoring the patient's adhesion to therapy. In the main section of this review, we discuss some of the most common treatment options for ocular diseases, with a special focus on posterior segment treatments, and summarize the most recent improvement deriving from thermosensitive drug delivery strategies. Aside from this, an additional section describes the most widespread in vitro models employed to evaluate the functionality of novel ophthalmic drug delivery systems.

Growing cava vein anastomosis: comparison of cross-clamping and suture times using VCS metallic clips, interrupted nonabsorbable, or continuous absorbable suturing techniques.

BACKGROUND: The latest generation in titanium clip application systems, the AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Burlington, MA), allows surgeons to perform vascular anastomosis more easily and faster than conventional sutures. This system may become the option of choice for vascular reconstruction in pediatric surgery where, as in the case transplant surgery, decreasing vascular occlusion times may influence outcome. The aim of this study was to determine whether VCS metallic clips would allow shorter anastomosis times than conventional interrupted polypropylene or running polyglycolic acid suturing in end-to-end anastomosis performed in the abdominal cava of young pigs. METHODS: Thirty-two domestic swine, 45 days old, were used for this study. All animals were subjected to an end-to-end anastomosis in the abdominal cava. RESULTS: VCS clips are easier to use for the surgeon, significantly decreasing cross-clamping time in caval anastomosis (VCS 10.33 ± 1.75 min vs. interrupted polypropylene sutures 46.00 ± 6.16 min vs. continuous polyglycolic acid sutures 18.16 ± 1.47 min). CONCLUSIONS: VCS clips significantly decrease the time needed for performing an end-to-end anastomosis in the abdominal cava, decreasing cross-clamping time when compared to interrupted polypropylene or running polyglycolic acid sutures.

[Titanium metallic clips: easier and faster than conventional suturing for heterotopic renal autotransplant in growing pigs]. / Clips metálicos de titanio: una técnica de sutura más rápida y fácil de utilizar que las suturas convencionales en autotrasplantes renales heterotópicos en cerdos en crecimiento.

INTRODUCTION: When performing vascular reconstruction in growing elements, specifically in paediatric transplant surgery, where a short vascular occlusion time is mandatory, master and easily handled suturing methods are needed. Thus the present study compares conventional continuous suturing with polypropylene and dexon versus easier and faster to apply titanium clips in heterotopic renal autotransplants. MATERIAL AND METHODS: 24 growing pigs were used for this study. Heterotopic renal autotransplant was performed when the animals were 45-days-old using VCS clips, continous Polypropylene or Dexon suturing when anastomosing the renal artery and vein to the aorta and cava in an end-to-side fashion RESULTS: VCS clips were easy to use for the surgeon, significantly (P < or = 0.001) decreasing the time needed for end-to-side anastomosis of the renal artery to the aorta (clips, 5.31 +/- 0.80 min/Polypropylene, 14.25 +/- 2.25 min/Dexon, 14.37 +/- 2.97 min); and also the time needed for end-to-side anastomosis of the renal veins to the cava (clips, 8.25 +/- 1.98 min/Polypropylene, 16.25 +/- 2.96 min/Dexon, 19.00 +/- 4.50 min). CONCLUSIONS: The use of VCS clips in heterotopic renal autotransplants significantly decreases the time needed for vascular reconstruction, compared to conventional suturing.

Clips metálicos de titanio: una técnica de sutura más rápida y fácil de utilizar que las suturas convencionales en autotrasplantes renales heterotópicos en cerdos en crecimiento / Titanium metallic clips: easier and faster than conventional suturing for heterotopic renal autotransplant in growing pigs

Introducción: En reconstrucciones de elementos vasculares en crecimiento y concretamente en la cirugía de trasplantes pediátricos donde disminuir el tiempo de clampado es muy importante se necesitan métodos de sutura que aporten rapidez y facilidad de manejo al cirujano, es así que hemos planteado un nuevo estudio experimental donde frente a las técnicas de sutura convencionales continuas con polipropileno y Dexon, planteamos el uso de clips de titanio con el objetivo de conseguir su fácil y rápida aplicación en Autotrasplantes Renales Heterotópicos. Material y métodos: Se utilizan 24 cerdos en crecimiento, que son sometidos a los 45 días de edad a un Autotrasplante Renal Heterotópico, con clips metálicos VCS, con técnicas de sutura convencionales continuas con polipropileno y con Dexon en anastomosis término-laterales de arteria y vena renal a la arteria aorta y vena cava. Resultados: Confirmamos que los aplicadores de clips VCS son más fáciles de utilizar para el cirujano y disminuyen significativamente (P≤0,001) el tiempo empleado en las anastomosis término- laterales de las arterias renales a la arteria aorta (clips, 5,31±0,80min/Polipropileno, 14,25±2,25 min/Dexon, 14,37±2,97 min); disminuyendo significativamente también (P≤0,001) el tiempo empleado en las anastomosis término- laterales de las venas renales a la vena cava (clips, 8,25±1,98 min/Polipropileno, 16,25±2,96 min/Dexon, 19,00±4,50 min). Conclusiones: Los clips VCS aplicados en Autotrasplantes Renales Heterotópicos reducen significativamente con respecto a las suturas convencionales el tiempo empleado en realizar las reconstrucciones vasculares (AU)

Introduction: When performing vascular reconstruction in growing elements, specifically in paediatric transplant surgery, where a short vascular occlusion time is mandatory, master and easily handled suturing methods are needed. Thus the present study compares conventional continuous suturing with polypropylene and dexon versus easier and faster to apply titanium clips in heterotopic renal autotransplants. Material and methods: 24 growing pigs were used for this study. Heterotopic renal autotransplant was performed when the animals were 45 days old using VCS clips, continous Polypropylene or Dexon suturing when anastomosing the renal artery and vein to the aorta and cava in an end-to-side fashion Results: VCS clips were easy to use for the surgeon, significantly (P≤0.001) decreasing the time needed for end-to-side anastomosis of the renal artery to the aorta (clips, 5.31±0.80 min/ Polypropylene, 14.25±2.25 min/Dexon, 14.37±2.97 min); and also the time needed for end-to-side anastomosis of the renal veins to the cava (clips, 8.25±1.98 min/Polypropylene, 16.25±2.96 min/ Dexon, 19.00±4.50 min). Conclusions: The use of VCS clips in heterotopic renal autotransplants significantly decreases the time needed for vascular reconstruction, compared to conventional suturing (AU)

New dental simulator for microsurgical training preliminary overview

No disponible

Objective: To present a new simulator designed at the Minimally Invasive Surgery Centre (Cáceres) which offers an integral, effective and viable training system that can be used for learning microsurgical techniques.Study design: A square methacrylate block was used. Animal jaws were fixed to the sides by means of butterfly screws.This block also has a drainage tube to facilitate the escape of fluids.Results: Excellent results were obtained using this simulator in microsurgical suturing training in dental, Oral and Maxillofacial SurgeryConclusions: We believe that this simulator is an essential component in microsurgical training. It is an ethically and morally valid training method with which various suturing techniques can be practised before using live animals and before applying these to daily clinical practice