Microsurgical Techniques Research Articles

Protocol to Develop a Core Outcomes Set for Peripheral Nerve Injury.

Background: Advances in treatment philosophies and microsurgical techniques for peripheral nerve injuries (PNI) have led to improved outcomes. However, lack of standardisation in the evaluation of clinical outcomes after PNI treatment precludes the ability to compare reconstruction methods, such as nerve transfer, nerve grafting, free functioning muscle transfers and tendon transfers. To this end, our goal is to work collaboratively to establish a core outcome set to evaluate outcomes after PNI. Methods: The protocol for this arc of work, delineated in this manuscript, consists of two phases: (1) conducting a systematic review of how outcomes are currently reported following PNI and (2) a Delphi process to gain consensus on the measures to include in the core outcome set for PNI. In the Delphi process, two online rounds will be used to gather consensus on the importance of each outcome measure. A final round will be conducted in person to discuss and resolve measures for which there is not yet consensus and to finalise the core outcomes set. Conclusions: Through this process, a common standard for reporting outcomes after PNI will be created, facilitating collaboration and future research.

MNGA-06 MANAGEMENT OF FORAMEN MAGNUM TUMORS, EXPERIENCE OF THE SERVICE OF THE ARRAZI HOSPITAL OF THE CHU MOHAMMED VI OF MARRAKECH

Abstract Tumors of the foramen magnum (FM) are intra or extradural expansive processes located in a region, very complex anatomically, limited, according to George and Al. Meningiomas and neuromas are the main tumors encountered intradurally, while extradural ones are mainly represented by chordomas and bone tumors. The objective of this work was to study the radio-clinical and anatomopathological characteristics, the place of surgery in the therapeutic management, as well as the prognostic factors of this pathological entity through a series of 10 cases collected at the service of Neurosurgery of the Mohamed VI of Marrakech, with literature review. The FM, unusual seat of expansive processes, gives passage to several vital anatomical structures which make the gravity and the particularity of this pathological entity. The preposterous clinical symptomatology, where no sign is pathognomonic, can simulate several other neurological disorders. MRI is the most useful and least invasive examination for the diagnosis and management of foramen magnum tumors. The optimal therapeutic option is total excision of the tumour. However, given the location, nature and tumor volume as well as the involvement of the vertebral artery, the surgical procedure may be limited to subtotal excision. Several surgical approaches have been described to increase efficiency and minimize operative morbidity. A midline posterior approach combined with microsurgical techniques yields good results. Postoperative complications can be dramatic and should be anticipated. The histological spectrum essentially includes meningiomas and neuromas. The prognosis largely depends on the early diagnosis and treatment, the preoperative neurological state, the location and extent of tumor excision, as well as the quality of care provided postoperatively.

A Comparative Study of Subinguinal Microscopic versus Open Surgical Varicocelectomy in Treatment of Primary Varicocele

Abstract Purpose To compare the outcome between microscopic and conventional subinguinal varicocelectomy regarding improvement in semen quality and pain resolution in patients who complain of varicocele-related infertility, pain, or both. Patients and Methods A prospective interventional non randomized controlled trial was carried out on 64 patients who met the criteria and allocated to two groups, group A (n = 34) underwent microscopic sub inguinal varicocelectomy, and group B (n = 30) underwent conventional sub inguinal varicocelectomy. A 3-month postoperative semen analysis was compared to the preoperative one, and pain was assessed preoperatively, 1 month and 3 months postoperatively. Results Both study groups showed significant improvement in the semen quality. Moreover, improvement in semen parameters was significantly higher in group A when compared to group B. Improvement in sperm concentration was 89.2 % and 41.7%, and in progressive motility was 100% and 50% for group A and B, respectively (P < 0.01). At 1 month and 3 months postoperatively, pain score was significantly lower in group A (Median = 0 & 0, respectively) in contrast to group B (Median = 2 & 0, respectively) (P < 0.01). Conclusion In patients who suffer from varicocele-related infertility or pain, microsurgical technique in sub inguinal varicocelectomy gives better results in improvement of semen quality and pain resolution when compared to the conventional technique.

Complications in Prolonged Intraoperative Ischemia Time in Free Flap Breast Reconstruction: A Systematic Review and Meta-Analysis.

Autologous tissue transfer is an effective option for breast reconstruction post-mastectomy, with microsurgical techniques continually evolving. However, a comprehensive analysis of the relationship between prolonged ischemia time during free flap-based breast reconstruction and increased postoperative complications is still lacking. A systematic review and meta-analysis were conducted following PRISMA guidelines. Methodological quality was evaluated using the MINORS criteria. Studies meeting inclusion criteria were analyzed for total complications, complete and partial flap loss, and secondary outcomes. Data heterogeneity and risk ratios were assessed. Seventeen studies encompassing 5636 patients and 6884 free flaps were included. The mean age of patients was 49.43years (95% CI: 48.27-50.60), with a mean BMI of 26.09 (95% CI: 21.97-30.21), and an average post-harvesting free flap ischemia time of 70.35min (95% CI: 56.71-83.98). These analyses revealed a heightened risk of total complications (RR: 1.99, 95% CI: 1.61-2.46), complete flap loss (RR: 3.15, 95% CI: 1.32-7.52), partial flap loss (RR: 1.91, 95% CI: 0.92-4.00), hematoma (RR: 1.79, 95% CI: 0.96-3.32), and infection (RR: 2.12, 95% CI: 1.32-3.42) in cases with ischemia time exceeding 60min. Venous complications predominated in free flap failure cases. Effectively managing ischemia time could be crucial in free flap breast reconstruction to potentially reduce postoperative complications. Although there is a correlation between managing ischemia time and reducing postoperative complications, further research is needed to investigate the possible causation behind this relationship. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Микрохирургическая подпаховая варикоцелэктомия в лечении первичного варикоцеле. Опыт университетской клиники урологии РНИМУ им. Н.И. Пирогова.

Introduction. Varicocele is a common condition in men that affects fertility. There are many options for varicocele surgical treatment. Marmar operation shows the best results. Purpose of the study. To study the efficiency of microsurgical varicocelectomy among initially operated patients. Materials and methods. We performed microsurgical treatment in 198 patients with varicocele for 5 years in Pirogov First City Hospital. The mean age of patients was 28 years. 121 patients (61.1%) underwent surgery because of pain syndrome. Infertility was identified in 84 patients (42.4%). Pathospermia was determined in 147 patients (74.2%). Testicular hypotrophy was noted in 68 patients (34,3%). Results. Scrotal pain was relieved in 108 patients (90%). Within 6-36 months after the operation 25 couples (29.8%) had a natural conception. Improvements in sperm parameters were achieved in 104 patients (70.8%). Testicular volume increased at 2.0±0.5 ml in average. Postoperative hydrocele was observed in 5 patients (2.5%). Once wound suppuration was observed. No cases of testicular atrophy were identified. The recurrence rate was 3.5% (n=7). Conclusion. Microsurgical varicocelectomy is the optimal varicocele treatment in terms of efficacy, recurrence rate and complications. Using of microsurgical techniques and instruments makes it possible to identify precisely all venous trunks, including small collaterals, and minimize the risk of intraoperative injury of the testicular artery and lymphatic vessels. Marmar operation is the method of choice in initial treatment of patients with primary diagnosed varicocele.

Effectiveness of Lymphovenular Anastomosis and Complex Decongestive Therapy for the Treatment of Lymphedema in Patients with Breast Cancer: A Systematic Review.

Background: Lymphedema is a common breast cancer side effect, with an average incidence of 30%. The gold standard conservative treatment for lymphedema is complex decongestive therapy (CDT), which includes manual lymphatic drainage, compression therapy, skin care, and exercise. Lymphovenular anastomosis (LVA) is a microsurgical technique that intends to redirect excess lymphatic fluid to the venous circulation; this procedure is usually performed when conservative treatment fails. Therefore, the objective of this study is to evaluate the effectiveness of LVA and CDT for the treatment of breast cancer-related lymphedema (BCRL). Methods and Results: The search was performed in CENTRAL, MEDLINE, Embase, PsycINFO, SCOPUS, and LILACS. Inclusion criteria were (1) population: women with BCRL; (2) intervention: treated with LVA and CDT; and (3) outcome: primary outcome was lymphedema reduction. Secondary outcome was quality of life. Risk of bias and quality of study reporting were also assessed. The search found 3872 articles, with 5 articles meeting the PICO (population, intervention, comparison, outcomes) criteria, 4 pre-post studies, and one observational cohort study. The total sample included 2763 patients. Follow-up was variable. The follow-up varies from 7.8 to 120 months, with an average of 35 months. Lymphedema reduction was obtained in the five studies. Conclusion: The present systematic review suggests that for patients with lymphedema secondary to breast cancer, the combination of both treatments is effective in reducing the size of the limb and improving quality of life. Low-quality evidence was found for both limb circumference reduction and quality of life. Additional research effort is needed to reduce bias and improve the quality of evidence, in order to better inform clinical practice and enhance the care and well-being of patients with BCRL.

Advances in Microsurgical Treatment Options to Optimize Autologous Free Flap Breast Reconstruction

Introduction: Reconstructive plastic surgeons have made great strides in the field of breast reconstruction to achieve the best results for patients undergoing treatment for breast cancer. As microsurgical techniques have evolved, these patients can benefit from additional treatment modalities to optimize the results of the reconstruction. Free tissue transfer from alternative donor sites for breast reconstruction is routinely performed, which was not possible in the past. Neurotization is now possible to address the numbness and lack of sensation to the reconstructed breast. For those patients who develop lymphedema of the upper extremity as a result of their breast cancer care, supermicrosurgical options are now available to treat and even to prevent the development of lymphedema. This study presents a narrative review regarding the latest microsurgical advancements in autologous free flap breast reconstruction. Methods: A literature review was performed on PubMed with the key words “autologous free flap breast reconstruction”, “deep inferior epigastric perforator flap”, “transverse upper gracilis flap”, “profunda artery perforator flap”, “superior gluteal artery perforator flap”, “inferior gluteal artery perforator flap”, “lumbar artery perforator flap”, “breast neurotization”, “lymphovenous bypass and anastomosis”, and “vascularized lymph node transfer”. Articles that specifically focused on free flap breast reconstruction, breast neurotization, and lymphedema surgery in the setting of breast cancer were evaluated and included in this literature review. Results: The literature search yielded a total of 4948 articles which were screened. After the initial screening, 413 articles were reviewed to assess the relevance and applicability to the current study. Conclusions: Breast reconstruction has evolved tremendously in recent years to provide the most natural and cosmetically pleasing results for those patients undergoing treatment for breast cancer. As technology and surgical techniques have progressed, breast cancer patients now have many more options, particularly if they are interested in autologous reconstruction. These advancements also provide the possibility of restoring sensibility to the reconstructed breast as well as treating the sequela of lymphedema due to their cancer treatment.

Advances in Modern Microsurgery.

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores the historical development, advancements, and current applications of microsurgery in plastic surgery. Methods: The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term "(((microsurgery) OR (advances)) OR (robotic)) OR (AI)) AND (((lymphatic surgery) OR (peripheral nerve surgery)) OR (allotransplantation))" and manually checked for relevance. Additionally, a supplementary search among the references of all publications included was performed. Articles were included that were published in English or German up to June 2024. Results: Modern microsurgical techniques have revolutionized plastic surgery, enabling precise tissue transfers, improved nerve reconstruction, and effective lymphedema treatments. The evolution of robotic-assisted surgery, with systems like da Vinci and MUSA, has enhanced precision and reduced operative times. Innovations in imaging, such as magnetic resonance (MR) lymphography and near-infrared fluorescence, have significantly improved surgical planning and outcomes. Conclusions: The continuous advancements in microsurgery, including supermicrosurgical techniques and robotic assistance, have significantly enhanced the capabilities and outcomes of plastic surgery. Future developments in AI and robotics promise further improvements in precision and efficiency, while new imaging modalities and surgical techniques expand the scope and success of microsurgical interventions.

The Evolution of Carotid Surgery

This review traces the evolution of carotid surgery from its ancient roots to modern practice. The first significant appreciation of the carotid arteries’ role in cerebral ischemia was made by Johann Jakob Wepfer in his 1658 book on apoplexy, which described the separate blood supply to each cerebral hemisphere by the carotid arteries. The 16th-19th centuries saw initial attempts at carotid ligation, while the 20th century marked significant advancements. The first carotid endarterectomy (CEA) by DeBakey, Cooley, and Eastcott in the 1950s paved the way for a new technique in carotid surgery and many subsequent refinements in surgical techniques related to CEA. The latter half of the 20th century brought innovations such as patch angioplasty, microsurgical techniques, and intraoperative shunting, significantly improving outcomes. Pivotal clinical trials established CEA as the standard treatment for symptomatic carotid stenosis. The emergence of carotid artery stenting (CAS) in the 1980s introduced a less invasive alternative, sparking ongoing debates about optimal treatment strategies. Recent developments include transcarotid artery revascularization (TCAR) and transfemoral CAS, with studies comparing their efficacy to traditional CEA. Current research focuses on plaque morphology and novel diagnostic factors to further personalize treatment strategies for carotid artery stenosis.

Microsurgical breast reconstruction in the United States: a narrative review of the current state.

Breast reconstruction with microsurgical techniques allows for autologous reconstruction after mastectomy without the complications associated with alloplastic reconstruction. Autologous reconstruction has undergone significant improvement and now offers patients a variety of options depending on patient specific factors and aesthetic outcomes. This review aims to focus on the history of autologous reconstruction, operative considerations, general surgical techniques for flaps, and indications for choosing the ideal free tissue transfer for all medical specialties and not only plastic surgeons. A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to history of microsurgical options, surgical techniques, patient considerations, and contraindications were utilized for this review with the objective to simplify data for all non-plastic surgeon readers. In this study, we find that patient selection is critical in successful outcomes for microsurgical breast reconstruction. We find that abdominal free flaps are now considered gold standard for autologous reconstruction. However, reliable alternatives exist for patients who are not considered ideal candidates for this reconstruction. These include thigh-based flaps such as gracilis myocutaneous flaps, profunda artery perforator flaps, lateral thigh perforator flaps and trunk-based flaps such as lumbar artery perforator flap. Postoperative considerations involve clinical monitoring and enhanced recovery after surgery. The rate of reconstructive success and flap viability is greater that 95%, even in high-risk populations, and therefore risk stratification should be performed based on an individual basis. While there are no absolute contraindications to autologous reconstruction, relative contraindications do exist including obesity and elderly populations due to the increased surgical and medical complications. While implant-based reconstruction remains the predominant method of breast reconstruction in the United States, there have been many exciting advancements in autologous reconstruction that offers high aesthetic outcomes and patient satisfaction.

Dissecting and fusiform aneurysms of the superior cerebellar artery: anatomy, clinical presentation, and treatment outcomes.

The management of superior cerebellar aneurysms is still controversial. Although several techniques are available, the deep localization of the lesion and the limited number of cases increase the complexity of decision-making for optimal treatment. Only a few cases of dissecting and fusiform aneurysms of the superior cerebellar artery (SCA) are described in the literature, many of which are without long follow-ups. The study aims to offer an exhaustive retrospective analysis of patients affected by SCA fusiform and dissecting aneurysms treated at our institution from 2008 to 2023, highlighting outcomes and complications. Moreover, a comprehensive narrative review was performed. A total of seven patients were treated at our institution. After a title and abstract screen, fifty-five papers met the criteria for inclusion in the review. In our case series, conservative treatment was proposed as the first therapeutic option in four cases (57.1%), while endovascular treatment (EVT) was in three cases (42.9%). A good recovery was observed in 66% of patients presenting with subarachnoid hemorrhage (SAH), while every patient without SAH achieved a good clinical outcome. A poor outcome was observed only in one patient with a dissecting aneurysm causing SAH, who also suffered a pontine infarction. In the literature review, conservative treatment was proposed as a first therapeutic option in eleven cases (16.6%), open microsurgical techniques in 19 patients (28.8%), and EVT in 31 patients (46.9%). Fatal outcome was documented in five patients (7.5%), all characterized by the rupture of the vascular lesion, while 6.1% of cases had non-fatal poor outcomes.

Results of surgical treatment of posterior cranial fossa meningiomas

Surgery of meningiomas of the posterior cranial fossa, due to its small volume and close anatomical relationship of neoplasms with the brain stem, cranial nerves, main arteries and venous collectors, remains one of the urgent problems of neurooncology. Despite the improvement of microsurgical techniques and neurophysiological control, maintaining a high level of quality of life after radical removal of meningiomas is still far from desired. Purpose of the study. Retrospective analysis and generalization of clinical results of surgical treatment of patients with meningiomas of the posterior cranial fossa. Material and methods. The paper analyzes the results of surgical treatment of 101 patient with meningiomas of the posterior cranial fossa of various localization (80 women (79.2 %) and 21 men (20.7 %), age 58.26 ± 1.00 years). According to the localization of meningiomas, they were distributed as follows: convexital – 49 (48.5 %), cerebellopontine angle – 22 (21.8 %), jugular foramen – 4 (4 %), petroclival – 16 (15.8 %), foramen magnum – 10 (9.9 %). Results. All patients underwent surgical removal of the formation. In 99 (98 %) one-stage and in 2 (1.9 %) cases of additional surgical intervention, in the form of external drainage according to Arendt and ventriculoperitoneal shunting, due to frolicking liquorodynamic disorders. Radical removal of meningioma (grade I according to Simpson scale) was achieved in 72 (71.3 %) of cases, tumor resection with coagulation of the tumor matrix zone (Simpson II) – in 21 (20.8 %), removal without resection and coagulation of the matrix, or leaving the extradural component of meningiomas (Simpson III) – in 8 (7.9 %). Conclusions. The results obtained on the basis of the complex use of modern neuroimaging diagnostic tools, microneurosurgery, optimal surgical approaches in combination with the mandatory intraoperative physiological control of the function of the brain stem and cranial nerves in the early postoperative period indicate an improvement in the functional state, and sometimes complete regression of the neurological symptoms in 58 (57.4 %) of operated patients. Complete regression of symptoms and restoration of the functional state was achieved in 30 (29.7 %) of cases, deterioration was noted in 17 (16.8 %) of the operated patients, mortality was 4.95 % (n = 5).

Biodistribution of PET radiotracers in tumor-bearing TRAMP mice administered by retroorbital or jugular vein injections

Nuclear medicine is an important tool for use in molecular imaging of important biological processes. Methods for intravenous delivery of radiotracers remains a challenge, with tail vein injections demonstrated to be technically difficult and lacking in reproducibility. Other intravenous methods include jugular vein (JV) injection, which requires a more invasive and precise microsurgical technique. Although the retroorbital (RO) sinus drains directly into the JV, and RO injections are minimally invasive and simpler to perform, they remain underutilized, perhaps due to a lack of studies demonstrating their performance. This study provides a comprehensive comparison of dynamic tissue biodistribution of three categories of commonly utilized radiopharmaceuticals between JV and RO injection methods in prostate tumor-bearing mice using PET-CT imaging. Results show that JV and RO injections have equivalent dynamic tissue biodistributions across the three categories of radiopharmaceuticals used: (1) small molecule measuring tumor metabolism (18F-flurodeoxyglucose [FDG]); (2) peptide-based probe measuring angiogenesis (64Cu-NOTA-PEG4-cRGD2); and (3) dextran-based nanocarrier (64Cu-NOTA-D20). Although RO injections present with some limitations such as type of injectate and difficulty for measuring acute, dynamic pharmacokinetics, this study demonstrates that RO injections are a viable, minimally invasive or stressful, and efficient alternative intravenous delivery technique for molecular imaging.

Hand Digit Revascularization: Could Be an "Elective-Urgence" Surgery?

Background: A continuous obstacle that has limited access to and implementation of finger replantation surgery is timeliness, as ischemia time is traditionally considered a crucial factor for success. However, claims that the vitality of amputated fingers decreases after 6 h of warm ischemia and 12 h of cold ischemia are mostly based on theoretical considerations. Methods: Here we present a case of multi-digit revascularization after 72 h of warm ischemia using the microsurgical arteriovenous bypass technique. Results: In the reported case, revascularization was performed after a long ischemic period and showed good recovery of motor and sensory function. Conclusions: We identified significant limitations in the literature supporting time limits of ischemia and recent evidence demonstrating the feasibility of delayed finger replantation. The current treatment approach for amputation injuries often requires transfers or nighttime emergency procedures, increasing costs and limiting the national availability of finger replantation. Changes to finger replantation protocols based on evidence could expand access to this service and improve the quality of care.

Computer Vision for Assessing Surgical Movements in Neurosurgery.

Objective evaluation of microsurgical technique quality is vital for successful training in neurosurgery. This study aimed to assess the accuracy of automatically detecting a neurosurgeon's proper posture and hand positioning using computer vision. We employed the RTMPose neural network model to identify key anatomical points in the neurosurgeon's projection and calculated various angles formed by connecting these points. By utilizing machine learning on these angles, we were able to classify images of the surgeon's posture and hands into correct positions and various types of errors with an accuracy of at least 0.9. Computer vision enables successful detection and objective assessment of the neurosurgeon's posture and hand positions. The high accuracy of this detection can pave the way for a new training approach in neurosurgery.

Comparison of Microsurgical and Conventional Techniques for Augmentation of Keratinized Mucosa Around Dental İmplants

Objective: This study aims to compare the clinical outcomes of periodontal microsurgery with conventional periodontal surgery in keratinized mucosa augmentation around the implant. Materials and Methods: Ten patients with at least 2 implants with a keratinized mucosal width of < 2 mm were included. Free gingival graft (FGG) was applied in the test group with the microsurgery technique whereas in the control group with the conventional periodontal surgery technique. Keratinized mucosa width (KMW) and palatal mucosal thickness (MT) were measured at baseline and 3rd month. Graft shrinkage(GS) was evaluated at the 3rd month. Donor site wound healing was evaluated at the 10th day and 3rd month. Feedback forms were collected on the 10th day. Results: KMW values increased significantly in both groups at 3rd month compared to baseline. The percentage of GS was lower in the test group at 3rd month, but this difference was not significant. MT values in the test group were closer to the baseline values at 3rd month compared to the control group. Wound healing scores were similar in both groups at the 10th day and 3rd month. Postoperative pain levels decreased more rapidly in the test group. Conclusion: The microsurgical technique provides a faster increase in palatal mucosal thickness and lower graft shrinkage during the healing period and an earlier reduction in postoperative pain levels.

Whole-Eye Transplantation: How Far Are We From a Breakthrough?

Traumatic facial injuries and resultant eye enucleation remain a devastating life-changing event for many. However, whole-eye transplantation (WET) has remained a distant goal until recently. This narrative review explores the existing literature on WET, assesses current hurdles to its success, and considers the ethical challenges to the expansion of WET programs globally. The authors identified pertinent keywords by conducting an initial literature exploration which were subsequently used to search scientific databases. In line with the narrative methodology employed in this article, specific inclusion and exclusion criteria were not explicitly defined. Nevertheless, the review focused exclusively on articles relating to ocular restoration and reconstructive surgery. Though vision restoration remains elusive, burgeoning surgical techniques such as vascularized composite allotransplantation have opened the scope for surgeons to consider WET when planning facial transplants. Dr. Rodriguez and the New York University Langone team's success supports the recent advancements made in surgical innovation and the potential of CD34-positive stem cells as neuroprotective agents when injected at the optic nerve connection of the recipient. For WET to succeed, vascular and neural structures and the transplanted eye must be considered. Such requirements have been strengthened by the development of microsurgical techniques. In addition to addressing the technical feasibility of WET, it is crucial to deliberate on ethical considerations such as the lifelong implications associated with immunosuppression and, challenges related to the fair division of ocular tissue for WET versus keratoplasty. WET amid significant facial trauma has great potential to restore the quality of life in patients, however, more research is required to demonstrate its long-term viability.

Combining three-dimensionality and CaP glass-PLA composites: Towards an efficient vascularization in bone tissue healing

Bone regeneration often fails due to implants/grafts lacking vascular supply, causing necrotic tissue and poor integration. Microsurgical techniques are used to overcome this issue, allowing the graft to anastomose. These techniques have limitations, including severe patient morbidity and current research focuses on stimulating angiogenesis in situ using growth factors, presenting limitations, such as a lack of control and increased costs. Non-biological stimuli are necessary to promote angiogenesis for successful bone constructs. Recent studies have reported that bioactive glass dissolution products, such as calcium-releasing nanoparticles, stimulate hMSCs to promote angiogenesis and new vasculature. Moreover, the effect of 3D microporosity has also been reported to be important for vascularisation in vivo. Therefore, we used room-temperature extrusion 3D printing with polylactic acid (PLA) and calcium phosphate (CaP) based glass scaffolds, focusing on geometry and solvent displacement for scaffold recovery. Combining both methods enabled reproducible control of 3D structure, porosity, and surface topography. Scaffolds maintained calcium ion release at physiological levels and supported human mesenchymal stem cell proliferation. Scaffolds stimulated the secretion of vascular endothelial growth factor (VEGF) after 3 days of culture. Subcutaneous implantation in vivo indicated good scaffold integration and blood vessel infiltration as early as one week after. PLA-CaP scaffolds showed increased vessel maturation 4 weeks after implantation without vascular regression. Results show PLA/CaP-based glass scaffolds, made via controlled 3D printing, support angiogenesis and vessel maturation, promising improved vascularization for bone regeneration.

Effectiveness of microsurgical palatal tonsillectomy in patients with oropharyngeal cancer and metastases of squamous cell carcinoma into the cervical lymph nodes without identified primary lesion

Introduction. Metastasis without an identified primary lesion is an unresolved and complex problem in clinical oncology. The issue of the necessity of primary lesion identification remains controversial. According to some studies, detection of the primary tumor potentially reduces the dose of radiation therapy and therefore prevents development of toxic reactions that reduce the quality of life of the patient, and in some cases completely eliminates the need for adjuvant therapy. Widespread development and application of robotic, microsurgical, and laser transoral techniques make it possible to verify latent oropharyngeal cancer. The detection of overexpression of p16 protein in metastatic affected lymph nodes may indicate the association of this pathology with human papillomavirus.Aim. To investigate the efficacy of microsurgical palatal tonsillectomy (using a surgical microscope) in diagnosis and treatment of occult oropharyngeal cancer in patients with cervical lymph node metastases of undetected primary site, determine the frequency of expression of the surrogate marker of human papillomavirus – protein p16.Materials and methods. The study was based on the results of diagnosing 82 patients with cervical lymph node metastases of undetected primary site. The inclusion criteria were morphologically verified cervical lymph node metastases of squamous cell carcinoma, absence of a primary tumour after a standard clinical examination. 10 patients underwent palatal tonsillectomy using a surgical microscope and cervical lymph node dissection based on the results of clinical examination and instrumental diagnostics.Results. The use of microsurgical palatal tonsillectomy in patients with metastases of squamous cell carcinoma in the cervical lymph nodes without identified primary lesion allowed to diagnose cancer of the palatine tonsil in 12.1 % of cases, cancer of this location associated with human papilloma virus in 70 % of cases.Conclusion. Microsurgical palatal tonsillectomy using a surgical microscope allowed us to not only verify occult palatine tonsil cancer, but also to establish accurate diagnosis and stage of the disease with subsequent determination of the scope of adjuvant therapy.

A Novel Training Model for Superficial Temporal Artery- Middle Cerebral Artery Anastomosis Using Microsurgical Techniques

To create a reusable and inexpensive training model with technological tools that simulates cerebral bypass surgery and a sensor system that provides tactile feedback to the surgeon. Furthermore, we aimed to evaluate the anastomotic stability and contribution to the surgeon's learning curve. We created a superficial temporal artery-middle cerebral artery bypass simulation model using chicken and turkey brachial arteries. A cranium model was printed with a three-dimensional printer for craniotomy and cerebral parenchyma was created by pouring silicone into the cranial mold. A blood flow simulation system was also prepared. Pressure-sensitive sensors were placed on parenchyma and tactile conditioning was performed via audible warning from the sensors. Twenty-four anastomosis were performed with different sutures and hand tools. Anastomosis completion times and durability and the number of touches and pressures applied to the parenchyma were recorded. The stability of the anastomoses was evaluated by increasing the pressure in the blood flow simulation system, so usefulness of the training model was evaluated. The time required for anastomosis completion decreased as the number of practices increased (P<0.05). As the number of practices increased, the number of parenchymal touches decreased (P<0.05). With practice, the time required for anastomosis completion and number of parenchymal touches decreased. Thus, the model is useful, inexpensive, reusable, easily accessible, and contributes to the surgeon's learning curve. Our model with pressure-sensitive sensors can be used for microsurgery practice, enabling the surgeons to gain tactile conditioning and evaluate anastomotic stability and leakage.