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Name:
Live Surgery Tuesday - Microsurgery
Description:
Live Surgery Tuesday - Microsurgery
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https://cadmoremediastorage.blob.core.windows.net/b511efe0-8675-4e78-a8fb-f293b29dae6d/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H28M22S
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https://cadmoreoriginalmedia.blob.core.windows.net/b511efe0-8675-4e78-a8fb-f293b29dae6d/Live Surgery Tuesday_ Microsurgery.mp4?sv=2019-02-02&sr=c&sig=pZn2jmaM9PZuyWoeA5mRgpH0opSMoQPgElEp9xrGP10%3D&st=2024-11-21T15%3A56%3A02Z&se=2024-11-21T18%3A01%3A02Z&sp=r
Upload Date:
2024-06-01T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Now OK, so Dr Badia. Here we are connected a little bit late. We actually had quite a bit of scar tissue here. And unfortunately just found a lot of scar around the tendon. So so some of you may not be able to even see the suture. It's that small. She had a partial cut on the ulnar side. And we're repairing that because it's kind of be like a zipper that nerve injury can open up.
But there we go. Good news for her is that she should recover the sensation very quickly. Partially because I took the scar away from the nerve, but. And also avoiding any issues. So you can see these are micro instruments. It's OK. It's retracting.
I'll show you we have a little what we call a lead hand, which is in this case, not lead. It's a French company, which I love who make some great products. OK so I don't know. I'm trying to get my camera to zoom in as much as possible. I don't know how close we can get in there, but I think the public needs to understand is that when we talk about microsurgery, we mean it's not small incisions like arthroscopy, which is in the next room.
I'm about to do a wrist arthroscopy. It's when you're using micro suture, typically a microscope. If you if you're experienced enough, you can do it with, scissors please, so these are micro scissors, very different than, say, these scissors, which are tenotomies. So these are actually large but micro scissors, but they're not bad.
I used to this is actually my set I bought about 25 years ago. We have about eight people that are watching you now and they're all greeting you in Spanish. So I think it'd be a good idea for you to greet them back in Spanish and explain Spanish. [Spanish] So so.
So switching back to English. OK even though we're Miami. But Spanglish. Spanglish Yeah. So this is called the lead hand. [Spanish] Don't pull too much because I've repaired this.
More distally, please. Oh, yeah, it is. So I'm going to release the pulley. This is just a part of your portfolio. So here's the tenderness. I didn't anticipate it. I mean, I put that it might be cut.
There it is. I mean, like that. So depending on the size. This is the flexor tendon. This is a flexor yeah. Yeah you'll see here how it flexes a finger. But if it involves less than 40%, the tendon depending may not need.
So what I'm going to do is get rid of that little frayed part so it doesn't trigger or get stuck in the sheath. [Spanish] What I'm debating now is if I should put a stitch there.
But let me see. So here's, here's a pulley, so I'm going to open a pulley a little bit more so it doesn't trigger. This is a great moment for you to explain trigger finger. Yeah so trigger finger for the lay public is when if the finger. If the tendon got stuck in this tunnel.
So [inaudible] please. Yeah we thought, you know, I indicated the patient for possible repair, but. Sorry, sorry. OK, so here's.
Right here. So I'm having trouble getting in there. OK so we're underneath the pulley. And if the tendon, if the tendon gets stuck, then the finger would catch or she wouldn't be able to make a full fist. So I'm going to do a little tendon gliding here and just see. So so you can see here, you see how the tendon glides, but the cut edge is right there.
So the question is, I'm still considering about a repair, but the tissue quality is not good. And part of it is the delay. What happens when the insurance company gets in my way of making clinical decisions and it's sitting on somebody's desk, my request to do a procedure, then this is the consequence, you see. So if this was a fresh cut, it would have been much easier for me to repair it.
Now it's there was a lot of scar tissue I had to remove. So now I'm making a decision. Frankly, I think I do need to repair it. Let me have 409 please. These are the consequences of a system that all of a sudden usurps the decision making of a doctor for bureaucracy. [Spanish] In English.
Is is it a Walant surgery? No, no. You know, there's a lot of different reasons, part of it is that my, I'm very lucky in that I don't really need to always do a lot because, you know, we have very good anesthesia here, it's very convenient for me, the patients, and I think there's a cultural component.
You know, honestly, a lot of my patients in Miami are a little bit anxious. I remember I did surgery in Hong Kong once and, you know, the patient needed no sedation and it. So here's our partial flexion tendon cut. So indeed, even I told you guys we are doing a nerve repair, it's the bigger part here is the, the tendon.
So, no, this is Walant. Walant for other listeners is wide awake, local anesthesia, no tourniquet. Which means that if there's no tourniquet, then the patient doesn't have the tourniquet pain. But to do that, you have to inject with epinephrine, which is, constricts of blood vessels.
And you know, it's good in many cases, but I don't do it routinely. A lot of my colleagues do it a lot more commonly than I do, which is great, but for a number of reasons I reserve it for certain cases. So if this was a tenolysis where I'm [inaudible] Yeah need more patient cooperation.
Exactly what's Kate suggesting there. So, Kate, give me a little flexion of the... [Spanish] And I said, is Kate, I think we should inject TM here to boost.
[Spanish] OK, irrigation.
Can we, can we call Gigi from my office to come and put the youth splint on? Yes so Dr. Badia is finishing up, but it was a ulnar digital nerve, micro repair. Actually radial. It was another little surprise.
I thought it would be. So it was radial, meaning the nerve was cut on this side and the flexor tendon repair. Exactly partial flexion tendon restoration repair. But if you'd like to see the entire procedure from the beginning, as soon as the live is over, the whole recording will post on our profile. We'll what we'll do is we can check in in a few minutes when we're putting the splint on.
So you can see the innovative splint, which is from Finland. It's a company called Dossier and they are a product called Ucast. And it is for those of you who are very green, it is sustainable, right? Or is that what we call it Kate? It's made out of basically, essentially wood. It's from Finland and it's very lightweight. Patients can now wash with it on.
And here we live in Miami, they can go in the ocean, in the pool. In this case, we won't because she has a wound. But to protect the repair, she's going to end up wearing it for a few weeks. OK we've got two questions in English. Theres no suture anchor use, just direct end to end repair. Yeah remember, this was a partial repair. So much easier.
I mean, the tendon has not really migrated, so it's a repair just to avoid the tendon from propagating more and also to avoid any catching of the edges of the tendon. OK next question is in Spanish. [Spanish] Another question.
Which suture material and number did you use? So for the nerve, I use 9.0 nylon, 9.0 nylon. And right now the closed skin I'm using vircryl rapide because we don't have to remove it. So it allows me to do what we call mattress stitches, which inverts the edges, makes the scar very nice. So, you know, either Kate or I will close and I'm staying on because you guys are such a wonderful audience.
They like to know the number. Yeah so this is 4.0 nylon. Can you show it to show them the repeat? The repeat is fantastic for my colleagues. You don't, Kate do we ever remove stitches in the office? Rarely. I mean, it's very, this flakes off in about 12 to 14 days. So it's designed for that.
[Spanish] Thank you so much.
OK, so let's see. Explain CTM. Thank you. So this is a connective tissue. Connective tissue matrix. This is a biologic. That has a growth factors will do two things will avoid excessive scarring, which is good, but it will also just help with the healing process.
So I'm going to put some under. [Spanish] Can we get a picture here? I have mine, one second. Kate I'll take it.
I'll get it. It's ready. It's already here. And come up. Yeah so we document this because we're looking at our clinical results of this. So Dr. Badia wears many hats. Surgeon/social media, including this hat given by Pedro Delgado for the Madrid.
I didn't go in person this time, unfortunately, but I gave a virtual lecture at his annual Madrid wrist arthroscopy course, which I hope he invites me to again in person. Because you cannot eat tapa and drink carnitas virtually. You can't. It's no fun to go over. Can you scoot over so we can tell you how we're going to get the split. Sorry I'm taking you out of your own surgery.
All right, you've got one more question, Dr. Badia. Yes, Tissue matrix, is it mainly being used for closure or just superficial. I've used in a variety of places. I've used it, what I've noticed is with big, with big laceration or big scars, I find that the wounds look much better, you know five, six days later. It does something to minimize that over exuberance of scar and edema.
But because there's growth factors also promoting healing. So it's an interesting combination of helping heal and will also prevent the excess of scar. So know, we've been using it now for a couple of years and I've been amazed with some of the results. I mean, one lady who had four, four previous surgeries to reflect your tendon, she's actually a celebrity in the Latin Latin television, but she couldn't believe five days after surgery, there was almost no swelling.
She was already moving after tenolysis. And I had never seen that before like that. And I really attribute that to this product. So we're [Spanish] I got to go.
Sure I'll have to to be honest with you. I'll be next door, though. Yeah perfect Yep. I got to go fix the wrist, guys, but wait for Gigi and you'll see this Usplint, which is amazing. She's heating it up now. So so, yeah, just while she's heating up, these splint, like Dr. Badia said, is, is a more eco-friendly.
It's a wood based material. So there is first a fabric layer that is used to protect the skin. And then there is the hard layer that actually immobilizes the patient. And the position we want is made out of a type of wood composite. I'm not sure of the exact mix, but that gets heated up so that it's moldable, malleable.
Gigi, one of our medical assistants and awesome cast and splint technicians is heating up now. And then we will go over to the patient. Thank you. Let's keep the patient space covered, please. Sure you work in a hospital? And so normally if we didn't have the Ucast available, we would have done first a softer task padding layer then a plaster layer and then we would have used this on the outside.
But because the UCAST is going to be what we're using for immobilization, we just do a very light dressing initially just to keep the sterile area where the wound, the surgical wound is, and then the grafts will go on top of it. If you could repeat again what the material is made out of, someone asks, is it poly, lactic acid or pga? But I don't know the exact mix, so I'm going to leave you in Gigi's hands.
Gigi is our, you are live, by the way. Surprise. Can I have you guys hold the hand? It is not with a heat gun. We actually put it in an oven. What was the time Gigi? Is it like 2 minutes in the oven? Now they're able to mold it to the patient.
And the oven is just right outside of the OR so she came in and it was already warmed up. And then this plane can be remolded at her post-op visit.
All right. Bye, guys. Bye, Kate. Thank you. Thank you. So we'll check in with her on Thursday when she comes in post-op. Thank you, everybody, for watching live.
Segment:0 .
Now OK, so Dr Badia. Here we are connected a little bit late. We actually had quite a bit of scar tissue here. And unfortunately just found a lot of scar around the tendon. So so some of you may not be able to even see the suture. It's that small. She had a partial cut on the ulnar side. And we're repairing that because it's kind of be like a zipper that nerve injury can open up.
But there we go. Good news for her is that she should recover the sensation very quickly. Partially because I took the scar away from the nerve, but. And also avoiding any issues. So you can see these are micro instruments. It's OK. It's retracting.
I'll show you we have a little what we call a lead hand, which is in this case, not lead. It's a French company, which I love who make some great products. OK so I don't know. I'm trying to get my camera to zoom in as much as possible. I don't know how close we can get in there, but I think the public needs to understand is that when we talk about microsurgery, we mean it's not small incisions like arthroscopy, which is in the next room.
I'm about to do a wrist arthroscopy. It's when you're using micro suture, typically a microscope. If you if you're experienced enough, you can do it with, scissors please, so these are micro scissors, very different than, say, these scissors, which are tenotomies. So these are actually large but micro scissors, but they're not bad.
I used to this is actually my set I bought about 25 years ago. We have about eight people that are watching you now and they're all greeting you in Spanish. So I think it'd be a good idea for you to greet them back in Spanish and explain Spanish. [Spanish] So so.
So switching back to English. OK even though we're Miami. But Spanglish. Spanglish Yeah. So this is called the lead hand. [Spanish] Don't pull too much because I've repaired this.
More distally, please. Oh, yeah, it is. So I'm going to release the pulley. This is just a part of your portfolio. So here's the tenderness. I didn't anticipate it. I mean, I put that it might be cut.
There it is. I mean, like that. So depending on the size. This is the flexor tendon. This is a flexor yeah. Yeah you'll see here how it flexes a finger. But if it involves less than 40%, the tendon depending may not need.
So what I'm going to do is get rid of that little frayed part so it doesn't trigger or get stuck in the sheath. [Spanish] What I'm debating now is if I should put a stitch there.
But let me see. So here's, here's a pulley, so I'm going to open a pulley a little bit more so it doesn't trigger. This is a great moment for you to explain trigger finger. Yeah so trigger finger for the lay public is when if the finger. If the tendon got stuck in this tunnel.
So [inaudible] please. Yeah we thought, you know, I indicated the patient for possible repair, but. Sorry, sorry. OK, so here's.
Right here. So I'm having trouble getting in there. OK so we're underneath the pulley. And if the tendon, if the tendon gets stuck, then the finger would catch or she wouldn't be able to make a full fist. So I'm going to do a little tendon gliding here and just see. So so you can see here, you see how the tendon glides, but the cut edge is right there.
So the question is, I'm still considering about a repair, but the tissue quality is not good. And part of it is the delay. What happens when the insurance company gets in my way of making clinical decisions and it's sitting on somebody's desk, my request to do a procedure, then this is the consequence, you see. So if this was a fresh cut, it would have been much easier for me to repair it.
Now it's there was a lot of scar tissue I had to remove. So now I'm making a decision. Frankly, I think I do need to repair it. Let me have 409 please. These are the consequences of a system that all of a sudden usurps the decision making of a doctor for bureaucracy. [Spanish] In English.
Is is it a Walant surgery? No, no. You know, there's a lot of different reasons, part of it is that my, I'm very lucky in that I don't really need to always do a lot because, you know, we have very good anesthesia here, it's very convenient for me, the patients, and I think there's a cultural component.
You know, honestly, a lot of my patients in Miami are a little bit anxious. I remember I did surgery in Hong Kong once and, you know, the patient needed no sedation and it. So here's our partial flexion tendon cut. So indeed, even I told you guys we are doing a nerve repair, it's the bigger part here is the, the tendon.
So, no, this is Walant. Walant for other listeners is wide awake, local anesthesia, no tourniquet. Which means that if there's no tourniquet, then the patient doesn't have the tourniquet pain. But to do that, you have to inject with epinephrine, which is, constricts of blood vessels.
And you know, it's good in many cases, but I don't do it routinely. A lot of my colleagues do it a lot more commonly than I do, which is great, but for a number of reasons I reserve it for certain cases. So if this was a tenolysis where I'm [inaudible] Yeah need more patient cooperation.
Exactly what's Kate suggesting there. So, Kate, give me a little flexion of the... [Spanish] And I said, is Kate, I think we should inject TM here to boost.
[Spanish] OK, irrigation.
Can we, can we call Gigi from my office to come and put the youth splint on? Yes so Dr. Badia is finishing up, but it was a ulnar digital nerve, micro repair. Actually radial. It was another little surprise.
I thought it would be. So it was radial, meaning the nerve was cut on this side and the flexor tendon repair. Exactly partial flexion tendon restoration repair. But if you'd like to see the entire procedure from the beginning, as soon as the live is over, the whole recording will post on our profile. We'll what we'll do is we can check in in a few minutes when we're putting the splint on.
So you can see the innovative splint, which is from Finland. It's a company called Dossier and they are a product called Ucast. And it is for those of you who are very green, it is sustainable, right? Or is that what we call it Kate? It's made out of basically, essentially wood. It's from Finland and it's very lightweight. Patients can now wash with it on.
And here we live in Miami, they can go in the ocean, in the pool. In this case, we won't because she has a wound. But to protect the repair, she's going to end up wearing it for a few weeks. OK we've got two questions in English. Theres no suture anchor use, just direct end to end repair. Yeah remember, this was a partial repair. So much easier.
I mean, the tendon has not really migrated, so it's a repair just to avoid the tendon from propagating more and also to avoid any catching of the edges of the tendon. OK next question is in Spanish. [Spanish] Another question.
Which suture material and number did you use? So for the nerve, I use 9.0 nylon, 9.0 nylon. And right now the closed skin I'm using vircryl rapide because we don't have to remove it. So it allows me to do what we call mattress stitches, which inverts the edges, makes the scar very nice. So, you know, either Kate or I will close and I'm staying on because you guys are such a wonderful audience.
They like to know the number. Yeah so this is 4.0 nylon. Can you show it to show them the repeat? The repeat is fantastic for my colleagues. You don't, Kate do we ever remove stitches in the office? Rarely. I mean, it's very, this flakes off in about 12 to 14 days. So it's designed for that.
[Spanish] Thank you so much.
OK, so let's see. Explain CTM. Thank you. So this is a connective tissue. Connective tissue matrix. This is a biologic. That has a growth factors will do two things will avoid excessive scarring, which is good, but it will also just help with the healing process.
So I'm going to put some under. [Spanish] Can we get a picture here? I have mine, one second. Kate I'll take it.
I'll get it. It's ready. It's already here. And come up. Yeah so we document this because we're looking at our clinical results of this. So Dr. Badia wears many hats. Surgeon/social media, including this hat given by Pedro Delgado for the Madrid.
I didn't go in person this time, unfortunately, but I gave a virtual lecture at his annual Madrid wrist arthroscopy course, which I hope he invites me to again in person. Because you cannot eat tapa and drink carnitas virtually. You can't. It's no fun to go over. Can you scoot over so we can tell you how we're going to get the split. Sorry I'm taking you out of your own surgery.
All right, you've got one more question, Dr. Badia. Yes, Tissue matrix, is it mainly being used for closure or just superficial. I've used in a variety of places. I've used it, what I've noticed is with big, with big laceration or big scars, I find that the wounds look much better, you know five, six days later. It does something to minimize that over exuberance of scar and edema.
But because there's growth factors also promoting healing. So it's an interesting combination of helping heal and will also prevent the excess of scar. So know, we've been using it now for a couple of years and I've been amazed with some of the results. I mean, one lady who had four, four previous surgeries to reflect your tendon, she's actually a celebrity in the Latin Latin television, but she couldn't believe five days after surgery, there was almost no swelling.
She was already moving after tenolysis. And I had never seen that before like that. And I really attribute that to this product. So we're [Spanish] I got to go.
Sure I'll have to to be honest with you. I'll be next door, though. Yeah perfect Yep. I got to go fix the wrist, guys, but wait for Gigi and you'll see this Usplint, which is amazing. She's heating it up now. So so, yeah, just while she's heating up, these splint, like Dr. Badia said, is, is a more eco-friendly.
It's a wood based material. So there is first a fabric layer that is used to protect the skin. And then there is the hard layer that actually immobilizes the patient. And the position we want is made out of a type of wood composite. I'm not sure of the exact mix, but that gets heated up so that it's moldable, malleable.
Gigi, one of our medical assistants and awesome cast and splint technicians is heating up now. And then we will go over to the patient. Thank you. Let's keep the patient space covered, please. Sure you work in a hospital? And so normally if we didn't have the Ucast available, we would have done first a softer task padding layer then a plaster layer and then we would have used this on the outside.
But because the UCAST is going to be what we're using for immobilization, we just do a very light dressing initially just to keep the sterile area where the wound, the surgical wound is, and then the grafts will go on top of it. If you could repeat again what the material is made out of, someone asks, is it poly, lactic acid or pga? But I don't know the exact mix, so I'm going to leave you in Gigi's hands.
Gigi is our, you are live, by the way. Surprise. Can I have you guys hold the hand? It is not with a heat gun. We actually put it in an oven. What was the time Gigi? Is it like 2 minutes in the oven? Now they're able to mold it to the patient.
And the oven is just right outside of the OR so she came in and it was already warmed up. And then this plane can be remolded at her post-op visit.
All right. Bye, guys. Bye, Kate. Thank you. Thank you. So we'll check in with her on Thursday when she comes in post-op. Thank you, everybody, for watching live.
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