nicely executed.....i hav certain questions.... 1.why the patient was taken up for reconstruction in 2nd surgery and simultaneous reconstruction wasnot performed during 1st one 2.if the patient was planned for 2nd surgery, flap could hav been raised and kept during first surgery, which could have made the vascularity of flap robust further and need to discard the distal part of flap could have been prevented... thank you
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.
Hi Dr Laurent Ganry Can you please guide me about any specialization in the field of Reconstruction Surgery..Im currently resident in Oral and Maxillofacial surgery and i want to pursue my future in reconstructive surgery specialization.. THANKS A LOT :)
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 Fadi Issa, You are probably referring to a Lateral Intercostal Artery Perforator (LICAP) Flap. It is typically used in partial breast reconstruction, but I do not have any experience of this flap for a posterior chest reconstruction like her. As any peforator flap, the LICAP flap can be harvest, but I will recommend in the clinical situation of this video a TDAP flap.
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!
Absolutely beautiful surgery. Wonderful teaching video! Thank you for such a descriptive and detailed video
Loved the technique of using bipolar as a dissecting forceps and also as a cautery..It was a great learning process..Thank you!
My Pleasure Arindam Jimmy!
Excellent
very Nice and educational video Dr.Laurent Ganry. Please post more such videos
Thank you Dr. Aravind Ramkumar! Will do!
Dr. Ganry that's a beautiful dissection !! Thank you for this great video !
Thank you Anastasiya Quimby! Glad you like it!
Nicely done!
@Rizwan Shiekh Thank you very much
Thank you !
Very informative video
Hope you can post other videos like these.
They are important learning material in resource limited areas.
Working on it. Thank you for your support!
Tremendous Preparation. Great teaching video.
Dear Kai Schröder, Thank you very much!
nicely executed.....i hav certain questions....
1.why the patient was taken up for reconstruction in 2nd surgery and simultaneous reconstruction wasnot performed during 1st one
2.if the patient was planned for 2nd surgery, flap could hav been raised and kept during first surgery, which could have made the vascularity of flap robust further and need to discard the distal part of flap could have been prevented...
thank you
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.
Hi Dr Laurent Ganry
Can you please guide me about any specialization in the field of Reconstruction Surgery..Im currently resident in Oral and Maxillofacial surgery and i want to pursue my future in reconstructive surgery specialization..
THANKS A LOT :)
do you use any doppler or CT Angio to mark your perforators. Is this 8 cm below the axilla and 2 cm behind the anterior border of LD constant
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.
Beautiful dissection, thank you! Have you ever raised this on the septocutaneous perforators between LD and serratus?
Dear Fadi Issa,
You are probably referring to a Lateral Intercostal Artery Perforator (LICAP) Flap.
It is typically used in partial breast reconstruction, but I do not have any experience of this flap for a posterior chest reconstruction like her. As any peforator flap, the LICAP flap can be harvest, but I will recommend in the clinical situation of this video a TDAP flap.
Many thanks Dr Ganry!
hi Dr.Ganry. May i ask how you record this video? with go pro or special surg cam?
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!
Great!
Thank you very much @truca90