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Novice Karate Group (ages 8 & up)

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INCISION Free Download (v1.1)



Objectives:Outline the different types of incisions used to access abdominal organs.Summarize the technique of introducing surgical instruments via the laparoscopic techniqueDescribe the benefits of the midline abdominal incision.Review the importance of improving care coordination amongst interprofessional team members to ensure that the patient with an abdominal pathology undergoes the appropriate surgical incision.Access free multiple choice questions on this topic.




INCISION Free Download (v1.1)



We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.


Injuries to the thenar muscle mass or motor entry point combined with high demanding patients are excellent indications for a FFPQ. Furthermore, thenar motor branch injuries and prolonged diagnosis with consecutive irreversible muscle damage can be reconstructed with a FFPQ. Due to the single incision procedure, intraoperative exploration of the thenar can then be extended by preparation and transfer of the FFPQ without the need of additional operation sites. Hereby compliance of the patient is as important as free joints to provide sufficient range of motion after regeneration. Still tendon transfers also require compliance and consecutive physiotherapy with the addition of cortical reeducation (Fig. 5).


Although injuries to the thenar motor branch or the muscles are rare, they can cause severe impairment of hand function. Hereby tendon transfers are the current standard for reconstruction of thumb opposition. In our study we demonstrate an alternative to tendon transfers with the free functional pronator quadratus flap. Especially young and demanding patients benefit from this procedure with excellent functional recovery of thumb opposition and grip strength. Due to minimal donor site morbidity and the superior benefit of a single incision surgery this flap is highly advantageous compared to other functional free flaps.


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Supine and prone approaches may have relative advantages and disadvantages. With the Lobenhoffer technique, it is impossible to manipulate all fragments in the case of a three-column fracture. In addition, with use of a medial approach, posterolateral column fractures may not be addressed appropriately [14,15,16]. Operating with the patient in the supine position allows the surgeon to intervene in all three column fractures simultaneously. For three-column fractures, the posterior column was buttressed with a posteromedial plate as the first step, and then the lateral column was elevated and/or reduced and fixed with relatively short proximal screws. As the final step, the medial column was reduced and fixed with a medial plate and screws inserted proximally from the lateral side were changed for longer screws (Fig. 3). The screws inserted from the lateral side are oriented toward the medial column and fix the medial column to the lateral column better than screws inserted from the medial plate, as these screws are oriented toward the posterolateral column rather than the lateral column. This was the reason for 2 mm displacement in a single case in our series. In this case, we had used an additional free screw inserted from the medial side going to the lateral column to compress the plateau. However, this single screw was not strong enough to prevent displacement and an additional 20 of genu valgum increased the vertical load on the medial column causing an acceptable amount of distal displacement of the medial column. In addition, after placing three plates we were able to fix the posterior column to the plate to increase the stability of the posterior column. This is impossible with posterior approaches as dynamic fixation of the posterior column with buttressing is essential until completion of reduction and fixation of the associated medial and lateral columns. With use of posterior approaches, it is impossible to intervene in the posterior column after changing the position of the patient, and if fixed to the plate in an inappropriate position, this will cause further deterioration of the medial and lateral columns. Therefore, rather than fixation of the posterior column, buttressing with a plate is the most common fixation technique for these injuries. In our series, we fixed the posterior column to the plate in four cases, and radiological and clinical results of these patient did not differ from the others despite the instability of the posterior column in these cases. Posterior approaches must be used for patients with posterolateral column fracture because accessing such fractures via a medial midline or posteromedial incision is very difficult. Although the direct posterior approach enables easy restoration of collapsed articular cartilage, it also has some disadvantages, such as superficial wound necrosis and flexion contracture [17, 18]. Some proponents of this technique have used this approach just to place a buttress plate rather than for elevation of a depressed lateral plateau or for fracture reduction, with elevation and final reduction of the lateral and posterolateral plateau using the anterolateral incision [6]. Thus, although it is inevitable that the posterior approach is used in the prone position in patients with posterolateral column fractures, using a medial midline incision in patients with posterior column or posteromedial column fractures facilitates both reduction of the posterior fragment and intervention of the injury globally.


Bring a sense of inspiration to your department as you and the clinical team help transform lives. From patient-specific planning to sub-millimeter precision, this incision-free treatment often results in an immediate therapeutic effect with minimal complications.


Safety of sub-tenon's blocks was reviewed in 2011. In the United Kingdom, a national Guideline on Local Anaesthesia in Ophthalmic Surgery (including sub-tenon's anesthesia) was published by the Royal College of Ophthalmologists and the Royal College of Anaesthetists (Anesthesiologists), 2012. This Guideline is available as a free download, from either College's website.


The PICO single-use negative pressure wound therapy device (Smith & Nephew, Inc., Andover, MA) is a single-use, canister-free, negative pressure wound therapy device. It is marketed for use in the following types of wounds: chronic; acute; traumatic; subacute and dehisced wounds; partial-thickness burns; ulcers (e.g., diabetic or pressure); flaps and grafts; and closed surgical incisions. The PICO system contains a disposable, 1-button pump, coupled with an advanced dressing that negates the need for a canister. The pump is pocket-sized and the dressing can be worn up to 7 days. 041b061a72


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