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Glad you like it my friend! Thank you for your support 🙏🏻

Blockout module from blenderfordental is an easy way to create the offset model for the boolean cut.

Thanks 🙏!

My pleasure! You can find the part 1 on the channel. All the best

Thanks @ Dr. Kaushik H. Sharma! I am used to raise flaps based on superficial temporal pedicle, and unfortunately this pedicle can be unreliable sometimes (small and reacting vasoconstricted artery, small or sclerotic vein...). So I am using a colore Doppler for its evaluation every time before the surgery. This gentleman of nearly 87 yo had a small artery with high blood flow in it (due to possible stenosis starting -- some elderly patients can have Horton disease, calcification, endothelial hyperplastic reaction due to high blood pressure, etc...). Therefore it was more reliable in this case to go to the neck +++.

Thank you for the explanation Dr. Ganry ! What is your email address ?

Thank you @Dr Adil Ali. Glad you enjoyed!

Thank you very much @Nilay Yalcin! Glad you have enjoyed this video. I try to share the way surgical technics makes sense for me. All the best from France!

@Tristan Pollon, merci beaucoup pour votre soutien. Pour ma part vous avez 2 types de situation : un besoin de tissu épais pour recouvrir du matériel orthopédique typiquement (excellent choix du lambeau latéral de bras) ou une situation plus simple avec un lambeau fin. Le problème est la présence ou non de l'artère radiale récurrente en cas de gros traumatisme du coude etc... rendant le lambeau latéral de bras à retro impossible. Si la situation est plus simple avec un besoin de tissu fin, je pencherais pour une solution perforante propeller à partir du bras ou de l'avant bras typiquement.

@@dr.laurentganry3063 Merci pour votre réponse. Peut-on confirmer la présence de la récurrente radiale avec un angioscanner pré-op ?

@@tristanpollon7582 oui vous devriez, vu que l'on peut voir des perforantes avec.

Dear Burak Sercan Ercin, I have published a paper on this topic explaining everything I have used (a modified go pro). Wishing you the best pubmed.ncbi.nlm.nih.gov/31009633/

@@dr.laurentganry3063 Dear Dr.Ganry. I have red it 3 days ago :) Which modification is the most important step. I am asking because i may not have an access to modify lens. For example may i record this quality video with gopro 9. Or gopro 9 + lens filter?

@@buraksercanercin6562 I can't advice you on another setting as I never tried. I am still using my camera from this publication. But I am sure a Go Pro 9 + lens filter will be something of high quality if you record in 60 fps and in regular mode (to remove the fish-eye distortion). The lens helps you to give a sens of reality to the camera. With it it sees exactly what your eye is seeing (same field of vision, same optical zoom). and finally the power pad and the card inside will help you to have a long time of recording depending on the type of surgery you are performing. Happy to have feedback from you on the go pro 9 if you try it! good luck!

@videos DTJournal, Thanks a lot!

@drsatyabodh@sdmuniversity.edu.in, please check the first Video of my channel for CT data transfer. Then go to imw.global/imw/#/video/all. I think you just have to register for free. It is the "International Microsurgery Website", where I have post a Webinar about this technology with quick recap about how to proceed with the first steps of Blender. Just look in the video library the video "Laurent Ganry - How to do 3D Modeling and Create Your Own Surgical Guides with Free Open Source Software" Wishing you the best!

Thanks a lot @Babu Muntimadugu

Blender.org

It's free.

@Mario Domingues, Thanks. I just send you the file. Best!

Thanks @truca90. Flushing the vessels is performed with heparin + saline, and avoiding vasoconstriction is obtained with papaverine.

Dr. Laurent Ganry thank you!

@Renzo Romero. Thank you. It is my pleasure! Just send to your email. Take care.

@Alejandre Velarde Baez, Thank you. For anatomy, please go to www.thingiverse.com You will have plenty of Free Mandibular STL file to download. Best

@nguyen loi, thanks! Just sent to your mail box! Best

Always a doppler. But acoustic rather than color is absolutely enough. In fact this perforator is so constant that sometimes I am not using it anymore (especially in large flap) but just a quick check with your Doppler and you will fill confident. Safety first for the patient.

Dear @Daniel Gonzalez Hernandez, thank you! It is send. Best

@Marc Laloux. Je vous remercie chaudement pour votre commentaire! Ce travail est typiquement fait pour ça! Pour visser la plaque, vous avez raison. La solution reste de placer le patient en occlusion dentaire afin de positionner correctement la plaque de reconstruction conformée sur le modèle 3D initial. On vient simplement glisser sous la plaque (déjà positionnée sur la mandibule) la fibula et que l'on visse à la plaque. On peut également transporter la fibula vissée sur la plaque au niveau de la mandibule mais je ne le recommande pas +++. Utiliser un marqueur reste enfin la dernière possibilité: vous faite un trou supplémentaire au niveau du guide d'ostéotomie de la mandibule qui servira de marqueur. La plaque de reconstruction devra simplement positionner au moins 1 de ses trous sur le marqueur pour avoir une sorte de point de départ.

@Neon Ghost, thank you very much for your kind words. Do you have an email address?

@@dr.laurentganry3063 As an maxface resident, I am planning to work on 3d techs by opensource tools in near future . And these videos are really helpful. Pls mail me at nijanta@gmail.com

Thank you Dr. Aravind Ramkumar! Will do!

@Farid Alifian, Thank you very much. Just Dowload software on their websites : it is free +++ (OsiriX for Mac, Invesalius for Windows / Meshlab / Netfabb / Blender) Just notice that Blender software changes of Interface (much more user friendly now) so you may not find the same presentation than in my video. But except the fact that button change of position you have everything +++ (If you don't like the new Blender version, just download a version before 2.8 and you will have the same interface). Good luck!

@Ebraheem Elbarbeer your email please. I will send you an anonymous file. I wish you a good work!

@@dr.laurentganry3063 nelbarbeer@gmail.com Thank you very much

Dear T H, Thank you for your questions. Basically, you never reconstruct in the same time a Dermato Fibro Sarcoma case when it is not absolutely mandatory (like in the face for example). You have to perform a Vertical Mohs Micrographic technique, otherwise you will have very high risk of incomplete margins. This is the Gold standard approach for this oncological disease. Then, if you have incomplete margins and tried to perform initially a flap autonomization, then you just killed your flap as it may be not suitable anymore for the the new defect design. Flap autonomization is very useful when you go up to the usual flap size and that was not the case here. TDAP Flap are known to be able to sustain this kind of length without any venous congestion if you designed and performed it properly. Best regards. LG

@@dr.laurentganry3063 sir...that means you waited till Histopathology report arrival...... wasnt the specimen sent for frozen section to assess for margins.....?

Dear @@Himanshu-iv7ul, Yes. I've waited a week time between the 2 surgeries. You cannot performed adequate Frozen sections in a specimen like this one. But you need a full reading of the specimen in a disease like DFS as there is usually more extension deep into tissue that what you can see +++. This is why Vertical Mohs Micrographic technique is the gold standard there.

@Ivan De Rezende Almeida, Thank you very much for your kind words. I created 2 cylinders of 3mm (for the screw head) and 2 mm (for the screw body) of diameter. I can send you the .STL file if you send me your email address. Best.

Nice! Of course I want. ivan.rezende.a@gmail.com thank you 😀👍🏼

@Luciano Engelmann Morais - Cirurgia Buco-Maxilo-Facial - Thank you very much! Will do!