Medicaltalks
Medicaltalks
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Multiple partial traumatic amputations
Multiple partial traumatic amputations
Patient suffered multiple partial traumatic amputations of the fingertips while operating a hydraulic cutter, severed finger were replanted using microsurgical technique!! When possible, the amputated part should be taken to the operating room before the patient for thorough debridement and examination under the microscope. The quality of the tissue, specifically the nerves and blood vessels, are examined before committing to the replantation. Identifiable structures should be tagged with suture or microclips. The first step in replantation is bone shortening and fixation. Bone should be shortened enough to take all tension off of the subsequent soft tissue repairs. Bony fixation is followed by extensor tendon then flexor tendon repair. Arterial repair should then be undertaken. No matter what the level of amputation, anastomosing intact and healthy arterial intima on each side of the repair is paramount to success.Nerve repair is then completed followed by vein repair. Lastly, soft tissue coverage of the repair is completed. Credit: @reconst.surg.col @medicalpedia
Medicaltalks
Medicaltalks
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Here is an incredible shot that demonstrates how small a developing pair of fetal lungs can be! Regardless whether they call the land, the sky, or the water their home, all reptiles, birds and mammals rely on their lungs for gas exchange. To fulfill the task of gas exchange, the lung possesses a huge inner surface and a tree-like system of conducting airways ventilating the gas exchange area. During lung development, the conducting airways are formed first, followed by the formation and enlargement of the gas exchange area. The development of the respiratory system begins at about week 4 of gestation. By week 28, enough alveoli have matured that a baby born prematurely at this time can usually breathe on its own. The respiratory system, however, is not fully developed until early childhood, when a full complement of mature alveoli is present. During weeks 4-7, an olfactory pit is one of a pair of structures that will enlarge to become the nasal cavity. The lung bud will bulge from the foregut and develop. The laryngotracheal bud will develop into the trachea and bronchial bud, which eventually become the bronchi and all other lower respiratory structures. By week 16, respiratory bronchioles form. The fetus now has all major lung structures involved in the airway. Once the respiratory bronchioles form, further development includes extensive vascularization, or the development of the blood vessels, as well as the formation of alveolar ducts and alveolar precursors. At about week 19, the respiratory bronchioles have formed. Major growth and maturation of the respiratory system occurs from week 24 until term. More alveolar precursors develop, and larger amounts of pulmonary surfactant are produced. The respiratory system continues to expand, and the surfaces that will form the respiratory membrane develop further. At this point, pulmonary capillaries have formed and continue to expand, creating a large surface area for gas exchange. The major milestone of respiratory development occurs at around week 28, when sufficient alveolar precursors have matured so that a baby born prematurely at this time can usually breathe on its own. Photo by @mrs_angemi
Noor
Noor
in Discussion | 6 days ago
Medicalpedia
Medicalpedia
in General
Squamous cell carcinoma of the lower lip reconstructed using "staircase" flap technique.
Squamous cell carcinoma of the lower lip reconstructed using "staircase" flap technique.
The most common cancer of the lower lip is squamous cell carcinoma (SCC). Micrographically controlled surgery (Mohs surgery) is the golden standard of therapy in localized SCC. Since the majority of lip cancer patients is >60 years of life, planning of surgery and reconstruction has to consider the age and co-morbidities. The staircase or step technique is a robust method to achieve a good functional reconstruction in a one-step procedure. The bilateral staircase technique of Johanson et al. can be used to close medial defects of one third to up to two-thirds of the lower lip. Basically it represents a skin-muscle-mucosal flap for lower lip reconstruction. The lip cancer is removed in a rectangular fashion with appropriate free margins. The cut goes through all layers including orbicularis muscle and mucosa. The staircase technique provides a good sensory and motor innervation with satisfying functional outcome. Meticulous haemostasis is necessary before any wound closure. For full-thickness defects a three-layer suture is performed with polybraided non-absorbable sutures for intraoral mucosa and vermillion and non-absorbale monofilamentous sutures for the cutaneous repair. The orbicularis muscle and submucosa are sutured by absorbable material like vicryl.
Medshots
Medshots
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Sarah
Sarah
in General
The History of Trepanning
Trepanning is one of the first operations ever carried out by mankind and goes all the way back to Neolithic times. Trepanning is in fact a procedure we still use in neurosurgery today. Learn about this ancient operation and how we have adapted it to modern times!
ISHITA JANA
ISHITA JANA
in Discussion | a day ago
Noor
Noor
in Discussion | a day ago
FH Awareness Day
FH Awareness Day
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FH Quiz
FH Quiz
FH Awareness Day is coming :) Test your knowledge.
Moniccca
Moniccca
in General
Immunology - Interleukin 1 (IL1) physiology and IL1 antagonist pharmacology
Buy PDFs here: http://armandoh.org/shop I design my own shirts please support :) "There are many IL1 cytokines but the most well known is IL1B. IL1B is normally produced by cells during inflammation in an immature form, requiring caspase 1 to activate it. IL1B is a potent inflammatory cytokine produced by the immune cells notably the innate immune system and epithelial cells during a stimulus such as inflammation or infection. IL1B increases adhesion molecules expression on vessels, promotes diapedesis, it is a pyrogen and stimulates fibroblast activity. IL1B is thus an attractive target for pharmacological agents. Anakinra is a IL1B receptor antagonist. Canakinumab is a monoclonal antibody which binds to IL1B cytokine, preventing its effect on cells. These are used in inflammatory disease including rheumatoid arthritis"
Andy Wells
Andy Wells
in General
Brain tumor surgery: Aggressive Rhabdoid GBM near motor cortex in a young lady with paralysis.
Video of surgical resection of rhabdoid glioblastoma (RGBM), most malignant astrocytic tumor of brain in a young lady who was brought to the hospital in near comatose state and nearly half paralyzed. Case presentation by Dr. Farhad Limonadi MD, director of neurosurgery at Eisenhower Medical Center. Edited by Camus Yu
Sarah
Sarah
in General
Respiration Gas Exchange
Medicogram
Medicogram
in General
POF
POF
Progressive ossifying fibrodysplasia (POF) is an autosomal dominant hereditary disease, which causes progressive ossification of the skeletal muscles, fascia, tendons and ligaments. That is, some tissues of the organism, such as muscles or tendons, ossify and become bone.
Irda
Irda
in General
Mitral Valve Repair in Barlow's Disease Using PTFE Neochords and Annuloplasty: The Bending Plasty
The author demonstrates how to repair a mitral valve with Barlow's disease without resecting the tissue of the prolapsing leaflet.
Medicolearning
Medicolearning
in General
Serotonin Syndrome
Serotonin Syndrome
Medicaltalks
Medicaltalks
in General
The incredibly tiny, delicate fetal heart. How can such a small heart pump enough blood to support life? Interestingly enough, the fetal heart does not have to pump blood to the lungs to pick up oxygen. It does not need a separate pulmonary artery and aorta. In the fetal heart, these two blood vessels are connected by a blood vessel called the ductus arteriosus. After birth, the ductus closes and a separate left pulmonary artery and aorta form. The fetal heart also has an opening between the upper chambers (the right and left atria) called the foramen ovale. It lets blood flow directly from the right atrium to the left atrium during fetal development, but closes after birth. So the ductus arteriosus and the foramen ovale are part of the fetal circulatory system before birth but disappear soon after birth. In most babies, these blood-flow routes naturally close up shortly after birth, when the baby's lungs and cardiovascular system take over. Because the fetal heart has a circulatory system different from the one the baby uses after birth, it may be days or weeks before some congenital heart defects are found. How many weeks old do you think this fetus was at this point of heart development?
Medicaltalks
Medicaltalks
in General
⚠️Femur fracture⚠️
⚠️Femur fracture⚠️
This case involved a femur fracture and ankle fracture! (both fractures on the same leg). Femoral shaft fractures can result from high or low energy mechanisms and are often associated with other serious injuries. The most common causes include automobile accidents, falls from heights, ground-level falls in individuals with osteoporosis, and gunshots. A trauma is typically involving a direct hit to the thigh or an indirect force transmitted through the knee. Operative fixation with intramedullary nailing is the best option to ensure union of the less severe fracture. External fixation is used in more extensive cases. In severe open femur fracture cases patients might need a surgery called open reduction and internal fixation (ORIF) in order to bring the bones back into place and help them heal. Screws, plates, sutures, or rods are used to hold the broken bone together to ensure the bone stays aligned while healing. “Open reduction” means surgery is needed to realign the bone fracture into the normal position. “Internal fixation” refers to the steel rods, screws, or plates used to keep the bone fracture stable in order to heal the right way and to help prevent infection. Under general anesthesia, an incision is made at the site of the break or injury, and the fracture is carefully re-aligned or the joint replaced. The hardware is installed, and the incision is closed with staples or stitches. The steel rods, screws, or plates can be permanent, or temporary and removed when healing takes place. Once the open reduction internal fixation is performed, a cast is usually applied. In the prehospital setting, what do you think would work best to stabilize the position of the injured leg? Photo by @savageparamedics
Medicalcortex
Medicalcortex
in General
Moniccca
Moniccca
in General
From Conventional Circuit to MiECC
This video shows the simple realization of minimally invasive extracorporeal circulation models, starting from a traditional system.
Andy Wells
Andy Wells
in General
VATS Technique for Diaphragmatic Plication
The authors present a video-assisted thoracoscopic technique for diaphragmatic plication due to phrenic nerve paralysis.
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