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We found 4 results for Children\'s National Medical Center in video

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Costochondral Graft Harvest for Laryngoplasty
video

Rib cartilage is the workhorse autogenic material for laryngeal airway expansion surgery. Most usually one will use the right-sided 5th or 6th rib as the donor site. A 2.5 cm incision is made directly over the rib, in the inframammary crease from the lateral aspect of the nipple to the sternal xyphoid process. Subcutaneous fat is removed. The overlying intercostal muscles are dissected up away from the rib, divided, and retracted-- effectively exposing the rib. Perichondrium is sharply incised on the superior and inferior borders of the rib. A posterior tunnel is elevated in asub-perichondrial plane using blunt instruments, just medial to the osseocartilagenous (OC) junction. A Doyen elevator is inserted into the tunnel and the rib is transected right at the OC junction. The rib is then elevated from lateral to medial in the subperichondrial plane. Such a manuever ensures that the plueral space will not be entered, protecting the pleural membrane from injury. Once the rib has been elevated to the sternal attachment, it is completely released. The pleura is inspected directly to confirm it has not been injured. The wound is filled with normal saline and 30 cm of water pressure valsalva is applied by the anesthesiologist for 30 seconds, to ensure no air is escaping the lung. The wound is closed in layers over a rubber band drain placed in a dependent position. One should be able to harvest 2.5-3 cm of cartilage. Post-operatively a chest radiograph is obtained to rule out pneumothorax DOI: http://dx.doi.org/10.17797/2jra6vjlud

Open Posterior Graft Laryngoplasty
video

This video highlights the key points of successful open posterior costochondral laryngoplasty. DOI: http://dx.doi.org/10.17797/i6v1c8ghhg

Total Calvarial Reconstruction for Increased Intracranial Pressure and Chiari Malformation
video

This procedure is a total calvarial vault expansion to correct pansynostosis in a three-year-old child. Total calvarial reconstruction is an open procedure that consists of removing bone flaps with an osteotome, outfracturing the skull bone edges with a rongeur to allow for future expansion, shaving down the bone flap inner table with a Hudson brace to create a bone mush for packing the interosseus spaces, and modifying then reattaching the bone flaps with absorbable plates and screws. This patient is status post craniofacial reconstruction for earlier sagittal synostosis. Second operations are uncommon after correction of single-suture synostosis, so this more aggressive technique represents an attempt to definitively correct the calvarial deformity and resolve the signs and symptoms of the attendant intracranial hypertension. Indications for surgery include cosmetic and neurologic concerns, here including a Chiari malformation and cervicothoracic syrinx. This educational video is related to a current research project of the Children’s National Medical Center Division of Neurosurgery regarding single-suture craniosynostosis and the factors that place children at risk for surgical recidivism in the setting of intracranial hypertension. Kelsey Cobourn, BS - Children's National Medical Center Division of Neurosurgery and Georgetown University Owen Ayers - Children's National Medical Center Division of Neurosurgery and Princeton University Deki Tsering, MS - Children's National Medical Center Division of Neurosurgery Gary Rogers, MD, JD, MBA, MPH - Children's National Medical Center Division of Plastic and Reconstructive Surgery and George Washington University School of Medicine Robert Keating, MD - Children's National Medical Center Division of Neurosurgery and George Washington University School of Medicine (corresponding author)

Use of Surgical Theater to Facilitate Resection of an Arteriovenous Malformation
video

Hepzibha Alexander, BSN – Children’s National Medical Center, Division of Neurosurgery and Georgetown University School of Medicine Ehsan Dowlati, MD - Children’s National Medical Center, Division of Neurosurgery and Medstar Georgetown University Hospital Deki Tsering, MS - Children’s National Medical Center, Division of Neurosurgery Robert Keating, MD - Children’s National Medical Center, Division of Neurosurgery and George Washington University School of Medicine (corresponding author)

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