A comparative evaluation of intrathoracic latissimus dorsi and serratus anterior muscle transposition

Background: Comparison of intrathoracic latissimus dorsi (LD) versus serratus anterior (SA) muscle transposition for treatment of infected spaces, broncho-pleural fistulae, and for prophylactic reinforcement of the mediastinum after extended resections following induction therapy. Patients and methods: Twenty LD and 17 SA transfers were performed for prophylactic reinforcement (11 LD; nine SA), and treatment of infections (nine LD; eight SA) from 1995 to 1998. Results: The 30-day mortality was 0% following prophylactic reinforcement and 29% following treatment of infections (three LD; two SA). Prophylactic mediastinal reinforcement was successful in 11 of 11 patients with LD and nine of nine with SA transpositions, and treatment of infected spaces in eight of nine patients with LD and two of three with SA transfers. Morbidity requiring re-intervention consisted of flap necrosis (one LD), bleeding (one SA), and skin necrosis over a winged scapula (one SA). Subcutaneous seromas and chest wall complaints were more frequent following LD (45 and 36%, respectively) compared with SA transfers (29 and 27%, respectively), whereas impaired shoulder girdle function was more frequent after SA than after LD transfer (27 vs. 21%). Conclusion: Intrathoracic LD and SA muscle transpositions are both efficient for the prevention or control of infections following complex thoracic surgery, and are both associated with similar and acceptable morbidity and long-term sequela

Simulation in vascular access surgery

In the last years, simulation training has become widespread in different areas of medicine due to social expectations, political accountability and professional regulation. Different types of simulators allow to improve knowledge, skills, communication and team behavior. Simulation sessions have been proven to shorten the learning curve and allow education in a safe environment. Patients on dialysis are an expanding group. They often suffer from several comorbidities and need complex surgical procedures with regard to their dialysis access. Therefore, education in evidence-based algorithms is as important as teaching of practical skills. In this chapter, we are presenting an overview of available dialysis access training modalities. We are convinced that simulation will become more important in the near future and has a substantial impact on strategies to improve aspects of patient safety. © 2015 S. Karger AG, Basel

Modulares Training in vaskulärer und endovaskulärer Chirurgie am Beispiel der Stiftung und Schule Vascular International

The partial shift from patient to model is a reasonable and necessary paradigm shift in surgery in order to increase patient safety and to adapt to the reduced training time periods in hospitals and increased quality demands. Since 1991 the Vascular International Foundation and School has carried out many training courses with more than 2,500 participants. The modular build training system allows to teach many open vascular and endovascular surgical techniques on lifelike models with a pulsatile circulation. The simulation courses cannot replace training in operating rooms but are suitable for supporting the cognitive and associative stages for achieving motor skills. Scientific evaluation of the courses has continually shown that the training principle established since 1991 can lead to significant learning success. They are extremely useful not only for beginners but also for experienced vascular surgeons. They can help to shorten the learning curve, to learn new techniques or to refine previously used techniques in all stages of professional development. Keywords Advanced training · Advanced training regulations · Training model · Vascular International · CertificationDer zumindest partielle „shift“ vom Patienten zum Modell ist für die Chirurgie ein sinnvoller und notwendigen Paradigmenwechsel, um die Patientensicherheit zu erhöhen und den verkürzten Weiterbildungszeiten in den Kliniken und den gestiegenen Qualitätsansprüchen gerecht zu werden. Seit 1991 wurden von der Vascular International Foundation & School zahlreiche Trainingskurse mit mehr als 2500 Kursteilnehmern durchgeführt. Das modular aufgebaute Trainingssystem ermöglicht das Erlernen einer Vielzahl offen-gefäßchirurgischer und endovaskulärer Operationstechniken an lebensechten, pulsatil durchströmten Modellen. Die Simulationskurse können das Training im OP zwar nicht ersetzen, sie sind aber geeignet, die kognitive und die assoziative Stufe des Erreichens motorischer Fähigkeiten zu unterstützen. Die wissenschaftliche Evaluation der Kurse zeigt durchgehend, dass das seit 1991 etablierte Trainingsprinzip zu signifikanten Lernerfolgen führen kann. Sie sind nicht nur für Anfänger sinnvoll, sondern auch für erfahrene Gefäßchirurgen. Sie können in allen Stadien der professionellen Entwicklung helfen, die Lernkurve abzukürzen, neue Techniken zu erlernen oder bereits angewandte Operationstechniken zu verfeinern. Schlüsselwörter Weiterbildung · Weiterbildungsordnung · Trainingsmodelle · Vascular International · ZertifikatModular trainin