Channel Title: WUSTL Learn Surgery Channel Description: This YouTube channel is in conjunction to our main website of https://surgicaleducation.wustl.edu/. These videos represent our sheer passion for delivering master video education to surgeons with the core principle of improving patient outcomes at a global level. Dr. Susan Mackinnon leads these efforts and the education program evolved over 30 years of our own clinical and translational efforts to improve recovery for patients. We realized that practicing surgeons tremendously value continuous training to provide the topmost level of care for patients, especially when surgical innovations evolve at an exponential rate. Our program targets practicing surgeons by providing a real and genuine experience of continued medical education through the visual medium of video. <video> Morton's Neuroma Decompression of the 3rd Webspace - Extended (Feat. Drs. Johnson and Mackinnon) Description: SURGICAL PROCEDURE Morton’s Neuroma Decompression of the 3rd Webspace - Extended Authors: Johnson JE1, Mackinnon SE2, Yee A2 Published: February 14, 2019 Author Information 1 Section of Foot and Ankle Surgery, Department of Orthopedic Surgery, Washington University, St. Louis, Missouri 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis, Missouri Standard Edition (190227.190227) Extended Edition (190227.190227) ABSTRACT Morton’s neuroma is a degenerative entrapment neuropathy with a predilection for the third common plantar digital nerve. The pathophysiology of this neuroma involves perineural fibrosis caused by compression by the leading-edge of the transverse intermetatarsal ligament and adjacent metatarsal heads, sustained by repetitive microtrauma of daily living. This includes applied pressure by pointed and high-heeled shoes. Patients typically present with forefoot pain that can be associated with burning, tingling, or numbness between the toes. In this case, the patient presented with a 5-year history of pain in the left 3rd webspace and failed conservative management. Decompression of Morton’s neuroma was performed by releasing the transverse intermetatarsal ligament and any proximal tendinous fascia from the transverse head of the adductor hallucis. Their pain and frustration associated with the neuroma were resolved. KEYWORDS Morton’s neuroma, compression neuropathy, 3rd webspace, transverse intermetatarsal ligament POSITION Supine. INCISION An incision is placed along the midline between the 3rd and 4th metatarsal shaft. The dots delineate the palpated head and base of the respective metatarsals. TABLE OF CONTENTS (EXTENDED) 00:00 Introduction 00:15 Orientation 00:39 Marking the Surface Anatomy for Incision 01:54 Incision 02:03 Exposure 02:25 Identifying Crossing Cutaneous Branches of Superficial Peroneal Nerve 04:25 Neurolysis of Cutaneous Branch Superficial Peroneal Nerve 04:51 Identifying the Dorsal Fascia Covering the Extensor Tendons 05:19 Dissection into the 3rd Webspace Between the 3rd and 4th Metatarsal Shafts 06:05 Retraction of Metatarsal Shafts Using Lamina Spreader 06:30 Blunt Dissection to Expose the Transverse Intermetatarsal Ligament 07:02 Exposure of Third Common Plantar Digital Nerve 07:50 Demonstrating the Biomechanical Pathophysiology of Compression Neuropathy 08:14 Incising the Transverse Intermetatarsal Ligament 08:56 Release of Distal Fascia of Leading-edge of Transverse Head of Adductor Hallucis 10:03 Neurolysis of Third Common Plantar Digital Nerve 12:00 Closing Explanation of Anatomy and Surgery 13:16 Credits </video> <video> Electrodiagnostic Indications for Cubital Tunnel and SETS Nerve Transfer (Feat. Dr. Mackinnon) Description: LECTURE Electrodiagnostic Indications for Cubital Tunnel and Supercharge Nerve Transfer Authors: Mackinnon SE1, Yee A1 Published: November 17, 2021 Author Information 1Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Lecture (Long) - Clinical Judgement (190216.190218) TABLE OF CONTENTS 00:00 Introduction 00:15 SURGERY 00:37 Benchtop Research for Supercharge End-to-side Nerve Transfer 01:55 Anterior Interosseous to Ulnar Motor Supercharge End-to-side Nerve Transfer 02:50 Long-term Outcome of Supercharge Nerve Transfer 04:27 CLINICAL JUDGMENT 04:41 Classification of Nerve Injuries 06:14 Percent Denervation for Functional Loss 07:09 Relationship Between Muscle Function and Percent Motor Neurons 09:30 Classification for Cubital Tunnel Syndrome 10:17 Nerve Conduction Studies and Electromyography 12:51 Algorithm for Surgical Management of Cubital Tunnel Syndrome 13:44 Algorithm for Flexor Profundus Tenodesis and Crossing Nerve Grafts 14:20 Case #1 - EDX Indications for a Mild Case of Cubital Tunnel 15:44 Case #2 - EDX Indications of Cubital Tunnel with Conduction Block 16:22 Definition of Conduction Block 17:05 Intraoperative Example of a Conduction Block at the Deep Motor Branch 18:16 Case #3 – EDX Indications of Cubital Tunnel with Severe Demyelination 20:01 Case #4 – EDX Indications of Cubital Tunnel and Supercharge Nerve Transfer 21:17 Case #5 – EDX Indications of Cubital Tunnel with Abnormal Pronator Quadratus 22:27 Case #6 – EDX Indications of Cubital Tunnel with Chronic Recipient 23:28 Case #7 – EDX Indications of Cubital Tunnel and Supercharge Nerve Transfer 24:10 Case #8 – EDX Indications of Failed Cubital Tunnel Surgery 25:28 SURGERY 25:32 Considerations of Surgical Technique in Supercharge and Guyon’s Canal Release 26:30 SUMMARY </video> <video> Proximal Interphalangeal (PIP) Joint Implant Arthroplasty - Standard (Feat. Dr. Boyer) Description: Proximal Interphalangeal (PIP) Joint Implant Arthroplasty Using a Volar Approach Authors: Boyer MI1, Yee A2 Published: September 7, 2021 Author Information 1: Department of Orthopedic Surgery, Washington University, St. Louis, Missouri 2: Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Standard Edition (210616.210616) ABSTRACT Proximal interphalangeal (PIP) joint arthroplasty can provide pain-free and functional restoration to the mobility and stability of the joint. In cases with less than 30 degrees of deviation in the coronal plane, silicone implant interposition arthroplasty can be used. While a dorsal approach is used most frequently, post-operative immobilization of varying amounts of time are required to allow for healing of the extensor mechanism. Although technically more demanding, the volar approach allows for immediate post-operative rehabilitation. In this case, a 65-year-old patient presented with painful osteoarthritis of the PIP joint of the right index finger, resulting in weakness of pinch and loss of motion. She has had a previous DIP arthrodesis. Plain radiographs revealed coronal deformity without sagittal malalignment, and 10-55 degrees of passive motion. A volar approach was recommended. This video describes the successful reconstruction of the index PIP joint using silicone implant arthroplasty from a volar approach. KEYWORDS Proximal interphalangeal joint, hand arthritis, PIP implant arthroplasty, volar approach, silicone implant POSITION Supine INCISION Combined Bruner and mid-axial incision along the PIP joint of the right index finger. STANDARD EDITION VIDEO TABLE OF CONTENTS (Standard) 00:15 Introduction 00:25 Pre-operative Imaging (X-ray) 00:35 Orientation 00:45 Pre-operative Examination of the PIP Joint 01:07 Placement of Incision 01:19 Incision 01:36 Exposure 01:39 Identifying Neurovascular Bundle of the Medial Aspect of Index Finger 01:44 Dividing Grayson Ligament and Following the Neurovascular Bundle Distally 02:11 Elevating the Neurovascular Bundle Medially 02:18 Exposure and Identifying the Flexor Sheath 02:36 Visualization of Flexor Sheath with A2 and A4 Pulley 02:34 Creating a Flexor Sheath Window to Expose the Flexor Tendons 02:44 Identifying the Flexor Tendons and Volar Plate 02:52 Creating a Volar Plate Flap Away From Its Proximal Insertion to Visualize the PIP Joint 04:13 Gentle Hyperextension of the PIP Joint to Visualize the Distal and Proximal Phalanx 04:23 Limited Resection of Distal and Proximal Phalanx to Create Parallel Heads 05:48 Visualization of Parallel Distal and Proximal Phalanx 06:09 Illustration of Limited Resection of Distal and Proximal Phalanx 06:14 Creating a Canal in the Distal Phalanx 07:00 Intraoperative Imaging 07:05 Developing a Canal in the Proximal Phalanx with Intraoperative Imaging 07:35 Refining Distal and Proximal Canals with Broach with Using Intraoperative Imaging 08:06 Insertion of Trial Implant to Assess Alignment and Stability 08:28 Final Bony Resection and Irrigation of Distal and Proximal Canals 08:44 Overview of the Anatomical Structures of the PIP joint 09:10 Insertion of Silicone Implant into the PIP Joint 09:26 Reconstructing the Volar Plate 10:22 Reconstructing the Flexor Sheath 10:50 Final Intraoperative Imaging 11:00 9-Weeks Post-Operative Outcome 11:11 Credits </video> <video> Interpreting Electrodiagnostic Studies for Management of Spinal Cord Injuries (Feat. Dr. Fox) Description: LECTURE Interpreting Electrodiagnostic Studies for Management of Spinal Cord Injuries Authors: Fox IK1, Yee A1 Published: November 17, 2021 Author Information 1 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Standard Edition (210315.210315) Extended Edition (210315.210315) ABSTRACT The interpretation of electrodiagnostic studies (EDX) for mid-cervical spinal cord injuries is crucial to determine whether nerve transfers is feasible for restoring upper extremity function. In this lecture, we discuss core concepts for nerve transfers in clinical scenarios of late SCI and early rescue for lower motor neuron injuries. Several SCI case studies are presented to interpret the EDX in this complex patient population and develop a management strategy for providing optimal outcomes. KEYWORDS Spinal cord injuries, mid-cervical, electrodiagnostic studies, nerve conduction studies, electromyography TABLE OF CONTENTS 00:00 Introduction 00:23 Tenodesis and Hand Function in Mid-Cervical SCI 00:52 Basic Concepts of Nerve Transfers in Tetraplegia 02:21 SCI Injury Patterns 02:54 Timing and Types of Nerve Transfers 06:15 Electrodiagnostic Testing 06:26 Predicting the Degree of Lower Motor Neuron Injury 08:09 Clinical Algorithm for Decision Making in SCI 08:39 Surgical Options Using Nerve Transfers for SCI 08.48 Nerve Transfers vs. Tendon Transfers 10:03 Nerve Transfer for Elbow Extension 10:53 Nerve Transfer for Hand Closing 12:40 Nerve Transfer for Hand Opening 13:46 Case #1 with Non-Time Sensitive Greater Than 10 Years Post-SCI 16:13 Case #2 with Non-Time Sensitive Greater Than 1 Year Post-SCI 21:08 Case #3 with Partial Time Sensitive Less Than 1 Year Post-SCI 23:24 Case #4 with Time Sensitive Less Than 1 Year Post-SCI </video> <video> Introduction to Microsurgery Description: MICROSURGERY Introduction to Microsurgery Authors: Pet MA (1), Brogan DM (2), Hacquebord JH (3), Yee A (1). Published: July 27, 2020 AUTHOR INFORMATION (1) Division of Plastic and Reconstructive Surgery, Wahington University, St. Louis, Missouri (2) Department of Orthopedic Surgery, Washington University, St. Louis, Missouri (3) Department of Orthopedic Surgery, New York University Longone Health, New York, New York DISCLOSURE No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. ABSTRACT This video introduces microsurgery by describing the setup for the operating room with one and two surgical teams, how to use an operating room microscope, proper body ergonomics, and techniques for handling microsurgical tools. KEYWORDS Microsurgery, operating room, operating microscope, ergonomics, tools and techniques TABLE OF CONTENTS 00:00 Introduction 00:40 Operating Room Setup 00:45 Two Surgical Team Setup 02:06 One Surgical Team Setup 03:20 Microscope Controls 05:17 Draping the Operating Microscope 06:46 Ergonomics 07:50 Microsurgical Tools and Technique 07:55 Microsurgical Standard Set of Tools 08:30 Microsurgical Techniques 08:31 Image Focus Using Microscope 09:02 Jeweler's Forceps and Curved Micro Scissors 09:51 Micro Clip Applier 10:21 Vessel Dilator and Micro Irrigation 11:17 Straight Micro Scissors 11:39 Arterial Spurt Test 12:12 Rizutti Forceps and ACLAND Clamps 12:46 Needle Driver and Nylon Suture 13:34 Cottonoid Patties 13:52 Weck-Cel Spears 14:01 Vascular Strip Test 14:35 Papaverine 14:54 Vein Sizer 15:24 Vein Coupler and Coupler Forceps 16:09 Credits </video> <video> Lateral Arm Free Flap Harvest - Extended (Feat. Dr. Pet) Description: SURGICAL PROCEDURE Lateral Arm Free Flap Harvest - Extended Authors: Pet, MA1, Yee A1 Published: September 4, 2020 Author Information 1 - Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Extended Edition (200529.200605) ABSTRACT The lateral arm free flap is a fasciocutaneous flap, which can also be modified to include muscle and/or bone. This flap is based upon the posterior radial collateral vessels within the lateral intermuscular septum between the triceps posteriorly, and the brachioradialis and brachialis anteriorly. The axis of the flap is marked on a line between the deltoid insertion and the lateral epicondyle. In this case, a traditional lateral arm flap is harvested, but it should be noted that extension of the cutaneous paddle across the lateral epicondyle and onto the proximal third of the forearm is reliable, and often useful. The patient in this video presented with a recurrent sarcoma in the right forearm with a previously radiated bed. After re-resection, there was a 6 x 12 cm wound overlying the ulnar border with exposed ulnar neurovascular bundle and ulna. This instructional video details the harvest of a lateral arm fasciocutaneous free flap for coverage of this defect. KEYWORDS free flap, posterior radial collateral artery, lateral intermuscular septum, radial nerve, lateral arm flap POSITION Supine. INCISION The axis of the flap is marked along the line between the deltoid insertion and the lateral epicondyle on the posterolateral aspect of the arm. The presence of perforating vessels along this axis is confirmed using a handheld doppler, and an elliptical flap is marked along this axis to incorporate the perforating vessels. TABLE OF CONTENTS (Extended) 00:00 Introduction 00:10 Case Presentation 01:03 Orientation 01:44 Surface Markings for Incision 03:55 Incision 04:26 Posterior Dissection of the Flap 05:00 Exposure and Identification of Tendon of the Triceps Brachii 06:34 Identifying the Longitudinal Perforator Vessel and Plane of Dissection 08:05 Dissecting the Flap from the Triceps Brachii 11:02 Following the Longitudinal Perforator Vessel Proximally 11:56 Identifying the Radial Collateral Vessels Supplying the Flap 12:10 Resecting the Triceps Muscle from the Lateral Intermuscular Septum 13:00 Extending the Incision Proximally for Additional Exposure 14:18 Dividing the Lateral Intermuscular Septum 15:20 Identifying the Posterior Brachial Cutaneous Nerve 16:47 Further Release of the Triceps Muscle from the Flap 19:50 Critical View of the Radial Nerve and Radial Collateral Artery and Vessels 20:36 Identifying the Vascular Branch to the Triceps 21:31 Anterior Dissection of the Flap 22:26 Identifying of the Brachioradialis an Brachialis 24:46 Elevating the Flap from Brachioradialis an Brachialis 28:04 Identifying the Longitudinal Perforator Vessel 29:06 Exposure the Humeral Attachment Anteriorly and Posteriorly 32:13 Incising the Humeral Attachment 33:01 Elevating the Flap Distally from the Humerus 34:46 Dividing the Anterior Branch of the Radial Collateral Vessels from the Radial Nerve 36:07 Dividing the Vascular Branch to the Triceps 36:31 Further Exposure of the Vascular Pedicle to the Flap 37:18 Dividing the Posterior Brachial Cutaneous Nerve 37:55 Identifying the Venous and Arterial Component of the Pedicle 39 33 Take Down of Tourniquet and Checking Perfusion of Flap 40:43 Dividing an Accessory Pedicle and Checking Perfusion of Flap 41:31 Clipping and Dividing the Radial Colleterial Artery and Vein to Mobilize the Flap 41:59 Post-Operative Results 42:35 Credits </video> <video> Revision Subtalar Arthrodesis with a Medial Femoral Condyle Bone Flap Description: Authors: Ribaudo JG, BS1, Thome A, MD1, Pet MA, MD1 Published: 3/20/2024 Author Information Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri Abstract In this video we review the case of an infected subtalar non-union treated with staged debridement and hardware removal, antibiotic spacer with culture directed antibiotic therapy, and finally with revision arthrodesis using a medial femoral condyle free flap. The surgical technique is documented in detail, with key pearls and pitfalls discussed by the surgeon. Key Words Subtalar, arthrodesis, medial femoral condyle, bone flap, plastic surgery Table of Contents 00:00 Introduction 00:22 Patient History 1:18 Subtalar Non-Union X-Rays 1:26 Surgical Plan 2:12 Spacer Removal 2:27 Osseous Defect 2:37 Recipient Site Preparation 4:54 Guide-wire Placement 5:36 Bone Flap Harvest 15:25 Flap Inset 18:28 Osteosynthesis of the Subtalar Arthrodesis with Anterograde and Retrograde Headed Compression Screws 18:58 Microvascular Anastomosis 19:34 Closure </video> <video> Lateral Arm Free Flap Harvest - Standard (Feat. Dr. Pet) Description: SURGICAL PROCEDURE Lateral Arm Free Flap Harvest Authors: Pet, MA1, Yee A1 Published: September 4, 2020 Author Information 1 - Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Standard Edition (200529.200605) ABSTRACT The lateral arm free flap is a fasciocutaneous flap, which can also be modified to include muscle and/or bone. This flap is based upon the posterior radial collateral vessels within the lateral intermuscular septum between the triceps posteriorly, and the brachioradialis and brachialis anteriorly. The axis of the flap is marked on a line between the deltoid insertion and the lateral epicondyle. In this case, a traditional lateral arm flap is harvested, but it should be noted that extension of the cutaneous paddle across the lateral epicondyle and onto the proximal third of the forearm is reliable, and often useful. The patient in this video presented with a recurrent sarcoma in the right forearm with a previously radiated bed. After re-resection, there was a 6 x 12 cm wound overlying the ulnar border with exposed ulnar neurovascular bundle and ulna. This instructional video details the harvest of a lateral arm fasciocutaneous free flap for coverage of this defect. KEYWORDS free flap, posterior radial collateral artery, lateral intermuscular septum, radial nerve, lateral arm flap POSITION Supine. INCISION The axis of the flap is marked along the line between the deltoid insertion and the lateral epicondyle on the posterolateral aspect of the arm. The presence of perforating vessels along this axis is confirmed using a handheld doppler, and an elliptical flap is marked along this axis to incorporate the perforating vessels. TABLE OF CONTENTS (Standard) 00:00 Introduction 00:10 Case Presentation 00:37 Orientation 00:50 Surface Markings for Incision 02:05 Incision 02:31 Posterior Dissection of the Flap 03:04 Exposure and Identification of Tendon of the Triceps Brachii 03:14 Identifying the Longitudinal Perforator Vessel and Plane of Dissection 03:41 Dissecting the Flap from the Triceps Brachii 04:55 Following the Longitudinal Perforator Vessel Proximally 05:17 Identifying the Radial Collateral Vessels Supplying the Flap 05:22 Resecting the Triceps Muscle from the Lateral Intermuscular Septum 05:41 Extending the Incision Proximally for Additional Exposure 06:21 Dividing the Lateral Intermuscular Septum 06:38 Identifying the Posterior Brachial Cutaneous Nerve 07:27 Further Release of the Triceps Muscle from the Flap 08:54 Critical View of the Radial Nerve and Radial Collateral Artery and Vessels 09:08 Identifying the Vascular Branch to the Triceps 09:43 Anterior Dissection of the Flap 10:06 Identifying of the Brachioradialis an Brachialis 11:29 Elevating the Flap from Brachioradialis an Brachialis 12:29 Identifying the Longitudinal Perforator Vessel 13:23 Exposure the Humeral Attachment Posteriorly 14:04 Incising the Humeral Attachment 14:27 Elevating the Flap Distally from the Humerus 15:24 Dividing the Anterior Branch of the Radial Collateral Vessels from the Radial Nerve 16:11 Dividing the Vascular Branch to the Triceps 16:26 Further Exposure of the Vascular Pedicle to the Flap 16:37 Dividing the Posterior Brachial Cutaneous Nerve 17:04 Identifying the Venous and Arterial Component of the Pedicle 17:42 Take Down of Tourniquet and Checking Perfusion of Flap 18:12 Dividing an Accessory Pedicle and Checking Perfusion of Flap 18:34 Clipping and Dividing the Radial Colleterial Artery and Vein to Mobilize the Flap 18:55 Post-Operative Results 19:11 Credits </video> <video> Speaking the Language of Electrodiagnosis for Nerve Surgery (Feat. Dr. Robinson) Description: LECTURE Speaking the Language of Electrodiagnosis for Nerve Surgery Authors: Robinson, LR Published: November 29, 2021 Author Information 1Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada Lecture (211129.211129 ABSTRACT Understanding the language of electrodiagnosis is important for surgical decision making in nerve surgery. In this lecture, we will review several topics from the perspective from an electrodiagnostician for treatment of nerve injuries, which includes (1) localization, (2) identifying the characteristics of demyelination and axonal loss, (3) severity and prognosis, (4) Martin Gruber anastomosis, (5) donor health for nerve transfers, (6) recipient health for nerve surgery, and (7) post-surgical recovery. KEYWORDS Nerve injuries, nerve conduction studies, electromyography TABLE OF CONTENTS 00:00 Introduction 01:33 Localizing the Nerve Injury 11:11 Demyelination or Axon Loss 17:24 Severity and Prognosis 27:20 Martin-Gruber Anastomosis 32:29 Donor Health for Nerve Transfers 33:26 Recipient Health for Nerve Surgery 38:50 Monitoring Recovery on EMG </video> <video> Interpreting Electrodiagnostic Studies for the Management of Nerve Injuries Description: LECTURE Interpreting Electrodiagnostic Studies for the Management of Nerve Injuries Authors: Mackinnon SE1, Yee A1 Published: September 22, 2021 Author Information 1Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Standard Edition (201012.201012) Extended Edition (201012.201012) ABSTRACT The accurate interpretation of electrodiagnostic studies (EDX) for nerve injuries is critical for determining appropriate management and achieving optimal outcomes. In this lecture, we build the foundations for understanding nerve classification of nerve injuries and review nerve conduction studies and electromyography. Furthermore, the concept of time-related changes to electrodiagnostic findings from the degree and timing of nerve injuries is presented with case studies. KEYWORDS Nerve classification, nerve injuries, electrodiagnostic studies, nerve conduction studies, electromyography TABLE OF CONTENTS 00:00 Introduction 00:23 Classification of Nerve Injuries 03:38 Rate of Recovery from Ischemic, Demyelination, Axonal, and Mixed Injuries 06:04 Referring EDX Reports 07:11 Electrodiagnostic Studies 07:30 Nerve Conduction Studies 07:40 Conduction Velocity 08:01 Amplitude 08:27 Conduction Block 10:25 Electromyography (EMG) 10:45 Spontaneous Activity 11:18 Fibrillations and Positive Sharp Waves 14:03 Insertional Activity 14:46 Motor Unit Action Potentials (MUPs) 16:50 Normal MUPs 17:01 Acute MUPs (Collateral Sprouting vs. Nascent Axonal Regeneration) 19:21 Chronic MUPs 19:43 EMG Findings for Complete and Mixed Fascicular Injuries 21:04 Percent Denervation for Functional Loss 22:25 Concept of Supercharge Nerve Transfers for Mixed Injuries 23:22 Surgical Management for Classification of Nerve Injuries 24:40 Management Review of Neurapraxia, Axonotmesis, and Neurotmesis Injuries 25:54 EDX Case Studies of Compression Neuropathy 26:00 Types of Conduction Blocks 27:36 Cubital Tunnel Syndrome with Conduction Slowing and Block 31:28 Compression of Radial Nerve at Spiral Groove with Conduction Block 31:46 Severe Carpal Tunnel Syndrome with Conduction Block 32:23 Clinical Correlations and Time-Related Electrodiagnostic Changes 33:26 CMAP Amplitude 33:53 Immediate Considerations of CMAP and SNAP Amplitudes 34:34 Fibrillations and Positive Sharp Waves 35:20 Collateral Sprouting MUPs 35:58 Nascent MUPs 36:16 Chronic MUPs 36:52 Case Study of Collateral Sprouting MUPs and Axonotmetic Injury 38:21 Case Study of Nascent Maturing to Chronic MUPs 41:00 Case Study of Neurotmetic Injury 41:31 Reference of EMG and Neuromuscular Disorders 41:40 Credits </video> <video> Proximal Interphalangeal (PIP) Joint Implant Arthroplasty - Extended (Feat. Dr. Boyer) Description: Proximal Interphalangeal (PIP) Joint Implant Arthroplasty Using a Volar Approach Authors: Boyer MI1, Yee A2 Published: September 7, 2021 Author Information 1: Department of Orthopedic Surgery, Washington University, St. Louis, Missouri 2: Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Extended Edition (210616.210616) ABSTRACT Proximal interphalangeal (PIP) joint arthroplasty can provide pain-free and functional restoration to the mobility and stability of the joint. In cases with less than 30 degrees of deviation in the coronal plane, silicone implant interposition arthroplasty can be used. While a dorsal approach is used most frequently, post-operative immobilization of varying amounts of time are required to allow for healing of the extensor mechanism. Although technically more demanding, the volar approach allows for immediate post-operative rehabilitation. In this case, a 65-year-old patient presented with painful osteoarthritis of the PIP joint of the right index finger, resulting in weakness of pinch and loss of motion. She has had a previous DIP arthrodesis. Plain radiographs revealed coronal deformity without sagittal malalignment, and 10-55 degrees of passive motion. A volar approach was recommended. This video describes the successful reconstruction of the index PIP joint using silicone implant arthroplasty from a volar approach. KEYWORDS Proximal interphalangeal joint, hand arthritis, PIP implant arthroplasty, volar approach, silicone implant POSITION Supine INCISION Combined Bruner and mid-axial incision along the PIP joint of the right index finger. TABLE OF CONTENTS (Extended) 00:05 Introduction 00:25 Pre-operative Imaging (X-ray) 00:35 Orientation 00:45 Pre-operative Examination of the PIP Joint 01:07 Placement of Incision 01:33 Incision 02:03 Exposure 02:13 Identifying Neurovascular Bundle of the Medial Aspect of Index Finger 02:24 Dividing Grayson Ligament and Following the Neurovascular Bundle Distally 03:07 Elevating the Neurovascular Bundle Medially 03:16 Exposure and Identifying the Flexor Sheath 04:25 Visualization of Flexor Sheath with A2 and A4 Pulley 04:35 Creating a Flexor Sheath Window to Expose the Flexor Tendons 04:55 Identifying the Flexor Tendons and Volar Plate 05:17 Creating a Volar Plate Flap Away From Its Proximal Insertion to Visualize the PIP Joint 07:55 Gentle Hyperextension of the PIP Joint to Visualize the Distal and Proximal Phalanx 08:05 Limited Resection of Distal and Proximal Phalanx to Create Parallel Heads 11:00 Visualization of Parallel Distal and Proximal Phalanx 11:33 Illustration of Limited Resection of Distal and Proximal Phalanx 12:02 Creating a Canal in the Distal Phalanx 12:56 Intraoperative Imaging 13:37 Developing a Canal in the Proximal Phalanx with Intraoperative Imaging 13:58 Refining Distal and Proximal Canals with Broach with Using Intraoperative Imaging 14:38 Insertion of Trial Implant to Assess Alignment and Stability 15:04 Final Bony Resection and Irrigation of Distal and Proximal Canals 16:01 Overview of the Anatomical Structures of the PIP joint 16:49 Insertion of Silicone Implant into the PIP Joint 17:21 Reconstructing the Volar Plate 18:47 Reconstructing the Flexor Sheath 19:27 Final Intraoperative Imaging 19:37 6-Weeks and 9-Weeks Post-Operative Outcome 20:01 Credits </video> <video> Morton's Neuroma Decompression of the 3rd Webspace - Standard (Feat. Drs. Johnson and Mackinnon) Description: SURGICAL PROCEDURE Morton’s Neuroma Decompression of the 3rd Webspace - Standard Authors: Johnson JE1, Mackinnon SE2, Yee A2 Published: February 14, 2019 Author Information 1 Section of Foot and Ankle Surgery, Department of Orthopedic Surgery, Washington University, St. Louis, Missouri 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis, Missouri Standard Edition (190227.190227) Extended Edition (190227.190227) ABSTRACT Morton’s neuroma is a degenerative entrapment neuropathy with a predilection for the third common plantar digital nerve. The pathophysiology of this neuroma involves perineural fibrosis caused by compression by the leading-edge of the transverse intermetatarsal ligament and adjacent metatarsal heads, sustained by repetitive microtrauma of daily living. This includes applied pressure by pointed and high-heeled shoes. Patients typically present with forefoot pain that can be associated with burning, tingling, or numbness between the toes. In this case, the patient presented with a 5-year history of pain in the left 3rd webspace and failed conservative management. Decompression of Morton’s neuroma was performed by releasing the transverse intermetatarsal ligament and any proximal tendinous fascia from the transverse head of the adductor hallucis. Their pain and frustration associated with the neuroma were resolved. KEYWORDS Morton’s neuroma, compression neuropathy, 3rd webspace, transverse intermetatarsal ligament POSITION Supine. INCISION An incision is placed along the midline between the 3rd and 4th metatarsal shaft. The dots delineate the palpated head and base of the respective metatarsals. TABLE OF CONTENTS (EXTENDED) 00:00 Introduction 00:18 Orientation 00:43 Marking the Surface Anatomy for Incision 01:25 Incision 01:32 Exposure 01:46 Identifying Crossing Cutaneous Branches of Superficial Peroneal Nerve 02:52 Neurolysis of Cutaneous Branch Superficial Peroneal Nerve 03:06 Identifying the Dorsal Fascia Covering the Extensor Tendons 03:22 Dissection into the 3rd Webspace Between the 3rd and 4th Metatarsal Shafts 03:57 Retraction of Metatarsal Shafts Using Lamina Spreader 04:05 Blunt Dissection to Expose the Transverse Intermetatarsal Ligament 04:27 Exposure of Third Common Plantar Digital Nerve 04:33 Demonstrating the Biomechanical Pathophysiology of Compression Neuropathy 04:44 Incising the Transverse Intermetatarsal Ligament 05:09 Release of Distal Fascia of Leading-edge of Transverse Head of Adductor Hallucis 05:43 Neurolysis of Third Common Plantar Digital Nerve 06:42 Credits </video> <video> Infraclavicular brachial plexus exposure Description: Exposure of the infraclavicular brachial plexus is necessary to access the cords of the brachial plexus and its branches. It provides access to terminal branches of the posterior cord, the axillary and radial nerves, prior to passing through the quadrangular space and triangular interval. Within this region are potential nerve donors such as thoracodorsal and medial pectoral nerves which can be used to reinnervate the axillary nerve and free functioning muscle transfers to restore elbow flexion. This video provides a demonstration of obtaining a broad exposure of the infraclavicular plexus by taking down the pectoralis major muscle and its subsequent repair. Position Supine Incision Deltopectoral groove References 1. Tender GC, Kline DG. The infraclavicular approach to the brachial plexus. Neurosurgery. 2008;62(3 Suppl 1):180-185. PMID: 18424984 2. Jerome JT. Anterior deltopectoral approach for axillary nerve neurotisation. J Orthop Surg (Hong Kong). 2012;20(1):66-70. PMID: 22535814 3. Ray WZ, Murphy RK, Santosa K, Johnson PJ, Mackinnon SE. Medial pectoral nerve to axillary nerve neurotization following traumatic brachial plexus injuries: indications and clinical outcomes. Hand (N Y). 2012;7(1):59-65. PMID: 23449552 </video> <video> An Overview of Nerve Conduction Studies and Electromyography (Feat. Dr. Bucelli) Description: LECTURE An Overview of Nerve Conduction Studies and Electromyography Authors: Bucelli RC1, Yee A2 Published: November 17, 2021 Author Information 1 Department of Neurology, Washington University, St. Louis, Missouri 2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Lecture (211013.211013) ABSTRACT Understanding the basics and fundamentals of electrodiagnostic studies (EDX) is critical for accurate and appropriate decision-making in the management of nerve injuries. In this lecture, we present an overview of nerve conduction studies and electrography from a neurologist’s perspective for nerve surgeons. This includes the importance of conduction velocity, CMAP, SNAP, spontaneous activity, and mother unit action potentials. The lecture describes clinical electrophysiologic correlations and finishes with a case study. KEYWORDS Nerve injuries, nerve conduction studies, electromyography TABLE OF CONTENTS 00:00 Introduction 00:22 Core Concepts in EDX 03:21 Technical Factors in EDX 06:31 Anatomy and Neurophysiology 10:09 Nerve Conduction Studies 10:17 Compound Muscle Action Potential (CMAP) 13:33 Conduction Velocity 15:22 Sensory Nerve Action Potential (SNAP) 19:06 Localization Via Sensory EDX 23:06 Electromyography 27:57 Analysis of Spontaneous Activity 32:47 Analysis of Motor Unit Action Potentials 41:07 Clinical Electrophysiologic Correlations 41:09 Timing of Acute Injury 42:21 Time-Related Changes 43:27 Sensory Nerve Conduction Studies Considerations 45:04 Demyelination and Conduction Block 46:15 Less Common “Upper Limb” Neuropathies 46:48 Case Study </video> <video> Repair of a Digital Nerve Laceration with an Acellularized Nerve Allograft - Extended Description: Repair of a Digital Nerve Laceration with an Acellularized Nerve Allograft Authors: Mackinnon SE1, Yee A1 Published: April 11, 2019 AUTHOR INFORMATION 1 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri Extended Edition (160614.160721) ABSTRACT There are many reconstructive options for repair of a digital nerve laceration. These options include direct repair, nerve conduit, or nerve grafting with the decision based on the core principle of nerve repair without tension. When direct repair is not an option, nerve reconstruction can include either an autograft, conduit, or acellularized nerve allograft. In this case, a 31-year-old patient presented nine-days following a laceration from a glass bottle to the right index ulnar digital nerve. The patient reported numbness in this sensory territory with significant pain at the injury site. Surgical exploration was indicated with discussed management depending on the findings and preference to not harvesting a nerve autograft for an injury of a non-critical digital nerve. The exploration revealed an 8 mm nerve defect with full finger extension with intact flexor tendons. Management proceeded with nerve grafting with an acellularized nerve allograft, given the injury was to a non-critical digital nerve. This video details the reconstructive nuisances for repair with an acellularized nerve allograft and includes details for microsurgical technique. DISCLOSURE The authors have no financial interest in any of the products, devices, or drugs mentioned in this production or publication. POSITION Supine. INCISION Brunner's incision proximal and distal to the injury on the medial aspect of the finger. TABLE OF CONTENTS (EXTENDED) 00:00 Introduction 00:20 Incision 01:02 Exploratory Dissection 02:07 Identifying the Proximal Injured Digital Vessel 02:36 Extending the Incision Proximally 03:28 Identifying the Proximal End of the Injured Digital Nerve 04:18 Distal Exploratory Dissection 06:08 Identifying the Distal End of the Injured Digital Nerve 07:11 Identifying the Distal Injured Digital Vessel 07:16 Exploring the Integrity of Flexor Tendons 08:06 Preparing the Proximal and Distal Ends of Digital Nerves for Grafting 09:28 Determining the Extent of Nerve Defect and Length of Nerve Graft 10:27 Preparing Length and Diameter of Acellularized Nerve Allograft 11:53 Microsurgical Technique and Suturing of Distal End 13:42 Microsurgical Technique and Suturing of Proximal End 15:57 Application of Fibrin Glue 16:11 Credits </video>

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This YouTube channel is in conjunction to our main website of https://surgicaleducation.wustl.edu/. These videos represent our sheer passion for delivering master video education to surgeons with the core principle of improving patient outcomes at a global level. Dr. Susan Mackinnon leads these efforts and the education program evolved over 30 years of our own clinical and translational efforts to improve recovery for patients. We realized that practicing surgeons tremendously value continuous training to provide the topmost level of care for patients, especially when surgical innovations evolve at an exponential rate. Our program targets practicing surgeons by providing a real and genuine experience of continued medical education through the visual medium of video.

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