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A-1129 Past, Present and Future of Hand Microsurgery
P. N. Soucacos, Greece
Thursday, June 14, 2018 · 2:52 p.m. · 28m 09s
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yeah
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this is chairman ladies and gentleman ah firstly i would like to think
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professor of frederick uh should read chairman of the scientific
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committee and the members of the scientific committee
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for this this thing on or to address my talk in such a high card or
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audience and now what i would like to share with you all ace
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to take it a journey to take it to the trip this say forty five fifty years
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ago when the micro surgery science the fate
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of my question is really started and
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take you with you from the past to the present and future
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and of course we must not be forgotten for jazz like alexis colour our
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who was the pioneer in
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making the antennas to moses in blood vessels something which was
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a a war there with the price of noble back in nineteen twelve
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and of course we all have to remember that back in the old times
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all the presentation cases if there were any were being down by makes the group
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of vascular another basic surges and that was the case for the boston are
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by a mall and mcconnell in nineteen sixty
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four and few here's after in my
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county grace were the great karma eh we're successful with a joint venture off
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they offer parts and uh a bachelors razors badly
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the great great start of micro surgery was scorned by the eh
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this paper by check option insurers micro shows you go on us the most of small vessels
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who'll calling also v. three am smoke magnification
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mike arrangements and mike or should josh
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and i have to pay tribute also to my
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professor and mentor doom or by nick
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in a duke university where i spend their five years that with him
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and we were able to do the first ever done
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it successfully public they shouldn't of the phantom
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in a few years after the triumph
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of a call magenta my in the in the first successful
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eh you plug they shove from ever done it in the word
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and they say you went back to my count three grace i was able to perform
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with a mayor of difficulties to over go over grout ago
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a a a number of or a presentation for shoes are related
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to incomplete non viable and complete eh amputations of the hand
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uh but uh going back to have to admit that that i cannot
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go to the operating room right away into a rehabilitation
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case unless we we are of well school
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in a the a micro surgery lab wits
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i not only inter using new techniques but also defines
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our clinical skills and also provide research facilities
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back in the all times a day and we're using as an experimental then
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you get some of the the the bracket large area of the cat
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which was compatible to the these a lot these envy fever all three of the card was
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vocal combined compatible to the common digital artist and of course the tomb but these gangs
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and then a uh all these eh brian you should
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your material and nils work eh brought up
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eh yeah who are accustomed to use nine o.
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n. ten or a four one emily be
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the diameter of us others which are compatible to the this a lot there is
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and each of the population who were had to use even smaller and thinner surgery like
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eleven or twelve all as the vessel diameter of the lemon in the does
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a lot of these children are being between point two two point five
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now all the stick the the bottom line is two things
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number on to do the inter obviously cheering on has three days you
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and number two without tension that's the name of the game
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and this is an example and this is a lot logic to the specimen and then it starts basement
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of a normal vessel and what if we do it should sharing
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with that now we get one into bar lie or proliferation
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how about nine or four layers will proliferation of the humour
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how about eight or a layer eight about prefer asian
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and look what's happening if we go seven or where most of the general sages dual heroes
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extensive in the market for for the for the duration which results to complete conclusion of them
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so as i said before we not be around a room filled
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which we hit with the the presentation yeah in micro surgery techniques was trauma
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and the the cerebral days you is classified that y'all now as complete
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or incomplete non viable and incomplete babble what's
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has to be low diagonals it checked counter the magnifier loops or a microscope
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and of course the same stands for major lane eh a
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amputation is at the eh any level of the upper
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arm eh is complete or incomplete no bible as in
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this case because she there as as though are
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that if we deal with a major label no less is given time than six hours
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and if we deal with these uh level around twenty four hours
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okay with the prerequisite that they re goes back
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date and hard but quilting is it oh
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with eh eh the transporting eh it facilities
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and of course you all know that we are divided
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the two groups the group of the amputated part
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a proximal and the the the the the part of the group of the distal part
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and the indication of question about our spending as you can see here
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the thumb having always a absolute a priority
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and the singer the the does pay you about the
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specific indications marty bitches mid palm as well
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and uh it also a race in a level this offered only for our
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and above elbow with the prerequisites in parameter that
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warms human is less than six hours anyway
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do you like to deal with guillotine type and
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a clean cut injuries is that off
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it crash injures like as a as a with severely mutilated
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part and a a vice and type of injuries
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so as i said before far uh has always absolute priority don't matter whether it's
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income plate non lab are complete viable
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and the the same thing goes core with rain injuries a route some type of
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eh it's race and he is a case which
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is a didactic because here they was
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only the skiing worse eh searcher then the result was eh the crosses of the
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eh ring finger and he again didactic case on the other the or the opposite side
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that the same kind of injury where one does a large thirty two
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dollars always worry per and exit cosmetic and functional is out
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was out come the same thing goes with eh injury it to a.
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o. or are the the style that the a. p. a. level
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yeah you see again if it is and it didn't like and compose it craft it a goes to the crosses
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similar case yeah after a repairing of it it does a
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lot is eh it a very good 'cause bit
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big and uh functional result at the end of the the i. p. level as i said before
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no huh uh i mentioned before about the single because it well we try now
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based on strictly the case was a single days only if it is the
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still to the session of the flexion digits are him so should lose
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because by these in which sex it just a plum base invented
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we get in nice so bloom is the is it
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a no question about eh multiple does of computational
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with right to replant as many as possible
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and of course we have in bear in mind to use the
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terms position michael tragedy that means delay people aren't the
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this damn us visit to the most useful stamp as in
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this case where we found out that the eh
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found was not rip one w. and would transfer and reap about the e. disfigured with the place of the thumb
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the same with by by a lot uh farms here eh it where we do the same eh thing
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as i said before made file has absolute indication
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because of this type of i'm cases cannot be compared
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even the best first is is the professors arbour so as presented
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and of course as i said before no as a rule of
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thumb every effort is made in which is the population
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so if we go go back to the success rate we're we're getting
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honestly talking we were getting a little bit ninety percent of or
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he both the groups that means these the level and a major lame
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and there we were encouraged to do some you know uh
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for a a really vascular radiation and the probation
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hey based on the technique the experience with a garden from our involvement in the eh
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these other than the artwork student days show
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that was the first hit regarding eh experience a we got
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by implementation but if trauma i mean but again that as so many
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other applications which were offered by the science of micro surgery
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and we were the size some few examples like barnet
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effects were vast because people are graft was yours
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hey either to the vast low rise or do i yeah i had a a do a
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arc there's a a stock so support in non union it should of roses cases
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n. in a vascular necrosis of the filler crap
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shall the vice vice fable or head is a great eh
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part of our our moment time it when we deal
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with major a injuries of the upper lower extremities
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where bony defect is larger than six started me this
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where we have our doubt that conventional methods are inadequate
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and always in cases like these in arbitration is a frightening
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option so using the art voiceless we will or
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either or as a single graft or a double draft
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or a double bottle then who are able
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two three eight cases like these fracture was one of the four are
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with say eh was initially use with all blurred actually internal fixation ended up with a
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should of roses then we did vice vice grassy both the eh
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a forum a and the result was of a bit
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satisfactory both eh a cosmetic early and function
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the same with model united fracture of all one of the four am
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i did this of other we're at double bar it was use
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and the again function and was missus was acceptable
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she said this result froze is where a home
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a a procedure which is to take all the dead ball
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and and not a viable material and replace it
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with vast as pornographic i it this is the procedure
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that is a solution to the difficult problem
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and in concerned that should have that have really good experience will call genders lovers of the t. v. a.
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but this is a pretty rare case of goods at that sure love rows of the red use
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where we the eh eh you again v.
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lakes of the radius using external fix
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it or device yeah then we bridge the gap with boss rise feeder graph
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this is the end result as you can see here the same with this should of roses
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of uh ass accessible eh eh conservative movie a humorous and
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we use uh it was supplemented hospice filter graph
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with a bomb of words and protein in both directions as in causes bone graft
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ten years post so and the case of quarters are common in a eight
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year old boy were was replaced with a vast rise fable or graph
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so the use of was lost but few the graph was it back
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i said a great asset in our eh strategic are moment value
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and we use that in court you use that in difficult case
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of a vast necrosis of the few more red you know this is a
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stated our days eh is by the the all the sophisticated procedures we have
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eh is it on salt problem and uh eh eh got the next
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because of more than five hundred cases of that and we
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eh if eh five to twenty five year survival is basically
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in stage one and two goes up to ninety
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but eh ninety five percent why are eh with the accumulate pushes you were more conservative
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and indeed using this technique he stays three and four were
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hey we can we can use it as a bind time procedure
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before the deterioration of arthritic changes needs it total hip replacement
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now i'm talking because in of a basic surgeon i'm not
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the plastic surgeon when nine e. face difficult plastic eh
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eh problems i asked my friend professor guess could help me
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but is it not the basics original we deal with a lot of trauma
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and in order to do so we have to have you know some flaps
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to do our work and you don't know the trend is flat
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my forever that can be used either is it i don't flop
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or a furry flab you versus alicia both the arbour
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eh in lower extremities the same with the sides because like the
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which is a very well known to you it's coupler floppy as well with the upper extremities
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and eh eh if i recall well
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we had to use not michael ravines labs micro venus
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graphs in twenty four percent of the cases and finally like our eh plastics
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a a colleagues are placing we do use perforated flaps where we do
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eh i we the us the benefit in the advances of not
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a having to do my covers for the unless the most
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and more uh regarding a application of micro surgery in
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the course tracking procedure likely constraint on numbers
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you we must admit that my great great majority of those need of no
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a surgical intervention is there any doubt presented with then soviet functional
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you permanent only ten percent of those needy as you this failure formation case
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eh in of a longitudinal fashion where we did a lot of um
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it allows for better with very good results regarding a paging and gas from of the hand
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and of course it no question about that because start that good yellow my courses are
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good technique is the body say station of the index finger which also provides
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you know good functional outcome and cosmetic appears as well
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and very lately i had it i was privileged to see one of my passions
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with eh with um hybrid plays yeah who was very happy with
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the result that she got half the thumb or the situation
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well i'm not going to speak about record lectures and objective backup palsy
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because we need sameness one after the other but it no
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all we we've got to admit how much this it
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by a difficult and non thoughts problems were eh eh
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it's helped with the back a surgical eh techniques
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anyway that was the past and the present what we're doing what we are doing
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how about future what are the new eh frontiers in perspective
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they just just them well the problem is how
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to deal with the issue loss even this
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coming from injury or a disease
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and like they is broke it came preaches is to replace same
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of the same this is the goal of a it doing
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a eh recourse directly micro surgery for these patients
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and we are entering in be here or of the artificial intelligence anyway
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have are really pension are moment i am of the
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therapy to prevent and treat those cases tissue engineering
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and of course c. t. a. composed issue are low
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transplantation or vascular rice composed out of transplantation
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and by compost these charlatans probation that it the case in the for the
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transplant patient of known life sustaining this just do a poster actually deficits
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a which is the is out of trauma or two more
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and they say said the eh it and i said and i was on the scroll by age
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group a. t. m. is to the the goal is to place same with the say
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a you know the statistics show that in america
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more than seven media people need compose the
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shallow transportation and this is way ahead
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of the numbers that they need for kidney
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eh ha lever heart or lung transplantation
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and in our days and in our family plastics off
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the basics hands surges researchers we eh mate
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to educational and clinical eh models the hand and face and
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it for this we use a to disciplines now
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because like my surgery and as a as we have talked about it when you know how to do it
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and transplantation surgery which includes though what eh
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the even know suppression age even drags
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and they say neater now so uh raised is you know which uh
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it gives all the archives all the case has to be done
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eh throughout the years starting with the very first case a
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followup of twenty years nobody exactly but not even young
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which was very amputated and this is the second case was was done in a the good the good tacky
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and then is doing well regarding the hand however at number of
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pick a complication like a vast when it grows in diabetes
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a present this is our shot and yes follow up the famous german by
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you the it team of edgar beamer the by lot are are
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so i'll andy if if we knew the i had me facial transplant patient
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a in a eh it done in france shall i talk about
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are composed to charlotte transplantation you have to define about
00:23:49
in order to transplant my little finger is time spent more difficult regarding out
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it's an easy eh s. tool as opposed to the solid organs
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eh which are comprised or just want you should like the days or hard or eh
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or a a line x. m. b. at its initiative is we all know is
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a lot oh yea regarding let's take art was or bone but severe
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and this refers to the rejection episodes they in skin and bone matter
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and the chronic even a suppression i'd i have the time is
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a solution but is eh eh eh associate with ann arbour
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of a side effects like or what you mistake
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infections organ failures malignancy austin the process
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so i'll see even a suppression is to see if joe
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words email no regulation that's the name of the game
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and the name of the game or so close to happen names tolerance and primaries
00:24:59
and primaries as you know is coming from the greek
00:25:04
mythological monster which comprised of a a a
00:25:12
the body of a lion the head of a coat and v. they love us they
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and that refers to i thirty at least two or three
00:25:23
genetic at the different this thing cells can call on such a course you live in the same
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eh organ it's so i if willie sexy don't cry
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maybe isn't we don't need any email suppression energy
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well this is what the future is a fraud of us
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but you don't have to forget the role of education
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and research and a as nasa model appointed the
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education and research are the most powerful weapons which
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you can use to change the work and
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this is absolutely true if we managing that knowledge in
00:26:11
nursing and of course you know for predicts in
00:26:13
plastic surgery answered it doubles every two to it when they have years and what will happen
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a within the next fifteen to twenty years
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regarding probably receive notice it has never ever been done
00:26:30
in the past two thousand years why is that
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because we are entering a new here the by all that is an h.
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the buyer informatics cage which are combination an merging of
00:26:46
by uh sciences information size and in physical size
00:26:52
and the all these have brought up the
00:26:56
eh concept of artificial intelligence that miss a bronze of computer
00:27:03
can amy makes the human brain
00:27:06
regarding learning function reasoning
00:27:12
and that is a a it is a proof on that which was a supported
00:27:19
by the accuracy of of a p. d. surgeon which prove the eh it
00:27:25
the the fact that was brought up by the eye at the fuselage it it it's it's
00:27:31
or it that there's immense i don't want to take much more of your time
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in order to make with the long story short yeah i would be i would like to be reminded of
00:27:42
what zero value brought up that there's no and in the world of micro surgery and one more if
00:27:51
we ask the jazz who were before us and our service we can say that
Conference Program
A-1127 President's Lecture: What 37 years with Hand Surgery have taught Me: Controversial Procedures that I still Perform and Procedures that I have Abandoned
Michel Boeckstyns, Copenhagen, Denmark
June 14, 2018 · 2:04 p.m.
137 views
A-1128 Honorary Lecture: The human hand: the most wonderful tool of nature
Zsolt Szabo, Miskolc, Hungary
June 14, 2018 · 2:31 p.m.
A-1129 Past, Present and Future of Hand Microsurgery
P. N. Soucacos, Greece
June 14, 2018 · 2:52 p.m.
A-1130 The Future of Hand Surgery
Henk P Giele, Oxford, UK
June 14, 2018 · 3:21 p.m.
226 views