HoloLens in Breast Reconstruction: What Is the Future?

Autologous breast reconstruction using the deep inferior epigastric perforator flap has been established as the standard for perforator-based free-flap breast reconstruction. This technique relies on the surgeon's ability to identify the patient's relevant abdominal vasculature to facilitate accurate dissection, optimize surgical outcomes, and minimize morbidity. A technique is described in which the authors incorporate augmented reality using HoloLens technology in their surgical planning to identify epigastric arteries and perforators.

Isolated post laparoscopic DIEA injury in bilateral DIEP breast reconstruction.

Scarring from previous open abdominal surgery in patients undergoing autologous deep inferior epigastric perforator (DIEP) breast reconstruction has been reported to increase overall flap and donor site complication rates. The evidence to date demonstrates that it can be performed safely although with significantly higher postoperative donor site morbidity. It would seem logical that minimal access laparoscopic surgery is less likely to be associated with increased risks to flap vascularity or donor-site complications; however, there is little evidence available in the literature about the impact of previous laparoscopic surgery to the DIEP harvest site.

Microsurgical refinements with the use of internal mammary (IM) perforators as recipient vessels in transverse upper gracilis (TUG) autologous breast reconstruction.

Background: The transverse upper gracilis (TUG) flap is the senior authors' second choice for autologous breast reconstruction when the DIEP flap is not available. It provides durable, pliable tissue with well hidden scars. The main criticism of this flap is the limited volume, donor site complications, short pedicle and vessel mismatch depending on which recipient vessels are used.

Microsurgery simulation training system and set up: An essential system to complement every training programme.

Introduction: Microsurgical techniques are essential in plastic surgery; however, inconsistent training practices, acquiring these skills can be difficult. To address this, we designed a standardised laboratory-based microsurgical training programme, which allows trainees to develop their dexterity, visuospatial ability, operative flow and judgement as separate components.

Method: Thirty trainees completed an initial microsurgical anastomosis on a chicken femoral artery, assessed using the structured assessment of microsurgical skills (SAMS) method.

Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients.

Background: Slim women are not always considered candidates for bilateral autologous breast reconstruction. The study aims to assess the volume considerations and complications of deep inferior epigastric perforator (DIEP) flap in bilateral breast reconstruction among slim patients.

Methods: All patients undergoing bilateral DIEP breast reconstruction at the Royal Marsden Hospital, London, September 2007-March 2015, were reviewed.

Overview of gynaecological and colorectal reconstruction.

Plastic surgeons are often required to reconstruct defects following radical pelvic surgery for advanced or recurrent anorectal and gynaecological malignancies. This article describes the most commonly used flaps for reconstruction following radical pelvic surgery and provides a treatment algorithm to facilitate decision making.

Prospective randomized controlled trial: fibrin sealant reduces split skin graft donor-site pain.

Background: Pain at split skin graft donor sites is common. Fibrin sealant has been demonstrated to reduce time to hemostasis at wound sites, and patients receiving this treatment were incidentally noted to report less pain. This study aimed to evaluate pain and incapacity in split skin graft donor sites treated with and without fibrin sealant.

Technical tip: coverage of the wrist arthroscopy tower using a sterile concentrical endoscopy camera drape.

Wrist arthroscopy allows complete visualization under magnification and is essentially a diagnostic and therapeutic tool. The first wrist arthroscopy was described by Chen in 1979. Since then, the indications and applications for wrist arthroscopy continue to expand as new techniques and instrumentation evolve.

Customised silicone prostheses for the reconstruction of chest wall defects: technique of manufacture and final outcome.

Chest wall reconstruction with a customised silicone prosthesis in 13 patients (five patients with pectus excavatum, six Poland's syndrome and two with post-surgical chest wall deformity) is presented. An alginate impression or CT scan with three-dimensional reconstruction was used to produce the final mould from which the silicone prosthesis was fabricated. The surface of the silicone implant was roughened to reduce capsular contracture and holes were incorporated to allow for tissue integration.