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Introduction: Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldès in France. The technique was then modified by different authors., Aim: This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris., Methods: We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris., Main Outcomes: A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting RESULTS: We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldès, We included the technical modifications and contributions described in articles published subsequently., Conclusion: Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM. Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;18:996-1008., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

The rising and the existence of plastic and aesthetic surgery in early modern Europe did not have a specific pattern, but was completely different from one nation to another. Colleges of Physicians could only be found in some places in Europe; different Parliaments of Europe's nations did not always elevate being a surgeon to the dignity of a profession, and being a surgeon did not always come with corporate and municipal privileges, or with attractive stipends. Conversely, corporal punishments for treacherous surgeons were ubiquitous. Rhinoplasty falls into the category of what Ambroise Paré named "facial plastic surgery". The technique is a medical source from which many histories derive, one more fascinating than the other: the history of those whose nose was cut off (because of state betrayal, adultery, abjuration, or duelling with swords), the history of those who invented the surgery of nose reconstruction (e.g. SuSruta-samhita or Tagliacozzi?), the history of surgeries kept secret in early modern Europe (e.g. Tropea, Calabria, Leiden, Padua, Paris, Berlin), and so on. Where does the history of Nicolae Milescu the Snub-nosed fall in all of this? How much of this history do the Moldavian Chronicles record? Is there any "scholarly gossip" in the aristocratic and diplomatic environments at Constantinople? What exactly do the British ambassadors learn concerning Rhinoplasty when they meet Milescu? How do we "walk" within these histories, and why should we be interested at all? What is their stike for modernity? Such are the interrogations that this article seeks to provoke; its purpose is to question (and eventually, synchronise) histories, and not exclusively history, both in academic terms but also by reassessing the practical knowledge of the 17th century.

Although direct exposure to procedures in the operating theater environment, together with practice on laboratory animals, is still seen as the gold standard of teaching in microsurgery, practice on nonliving simulators is currently being validated as an important educational tool. We reviewed the widely used nonliving training models, together with currently accepted innovations, which are parts of curricula of training courses in microsurgery. Using the experience accumulated in training programs at the Centre for Simulation and Training in Surgery, we identified which particular skills can be reliably targeted by each nonliving tissue exercise. We were able to find five groups of nonliving training models: basic manipulation, knot-tying principles, completing the anastomosis, the real tissue experience, and training in virtual reality. The more abstract models might seem quite far from the real life experience, but they each closely address specific skills. It thus becomes convenient for the instructor to train these skills separately. This generates series of consistently favorable results once the skills are integrated into a more complex procedure. Focused exercises, once assembled in continuity, reconstruct the real life scenario. The training program can comprise a series of increasingly difficult exercises, which mirror the real life situations. Performance on nonliving models in each progressively more challenging exercise can be assessed via direct observation, assisted by clear and objective criteria. Finally, focused training will help both the transition to human surgery and replication of the favorable results to large series of subjects., ((c) 2008 Wiley-Liss, Inc.)

Standard magnification in microsurgery is accomplished with the operating microscope. Loupes are perceived by the microsurgical community as technically less safe. However, after several years of microscope-only microsurgery, most of our microvascular procedures are performed under loupes 3.5-4x. Considering our results using loupes-only microsurgery, which are comparable with those obtained when using the microscope, we suggest that loupe-aided microsurgery might represent a natural progression for the experienced microsurgeon. Microsurgical skills and experience outweigh the importance of the magnification factor. While the microscope is mandatory for replantations distal to the palmary arch, microneurosurgery, and supramicrosurgery, loupes should be used in so-called "macro-microsurgery." One may include in this category replantations down to the palmar arch and free flaps with vessels more than 1.5 mm, such as the latissimus, serratus, (para)scapular, fibula, radial forearm, rectus abdominis, dorsalis pedis, omentum, and jejunum. Before starting loupes-only microsurgery, intensive training under the microscope is crucial. Less magnification does not mean less quality., (Copyright 2003 Wiley-Liss, Inc.)

Thirty-five years after Brescia et al. (N Engl J Med 275:1089-1092, 1966) realized the first peripheral autogenous arteriovenous fistula, the "Achilles' heel" of chronic dialysis is still the absence of a good-quality permanent vascular access. The number of patients depending on hemodialysis is increasing. Until 10 years ago, in Romania, there was a need to treat isolated critical cases. Nowadays, every dialysis center needs algorithms for a standardized approach, adaptable for each case. We reviewed 171 consecutive arteriovenous fistulas (132 patients) performed in adults in identical standard conditions: use of an inflatable tourniquet during the vascular dissection, microsurgical techniques, and use of only autogenous tissues. We analyzed our results, the technical difficulties encountered, and their management in long-term follow-up. The aim of this study was to set up the basic principles of our algorithms. Our approach, based on our education as plastic surgeons involved in hand surgery and microsurgery, might present the advantage of sparing renal patients vascular capital., (Copyright 2003 Wiley-Liss, Inc.)

We discuss 9 consecutive carcinomas developed on postburn scars. Our interest was focused on surgery, recurrence, metastasis and long-term survival. The delay between burn trauma and the first clinical manifestation was 25-63 years. The most common localisation was in the limbs (10). Two cases presented with visceral metastasis. We performed either wide excision and grafting (5) or amputation (5). From the anatomo-pathological stand point we encountered 8 SCC and 1 BCC. In 6 cases we had no local recidive or metastasis. One presented a local recidive. There were two deaths--lung metastasis and "spontaneous" rupture of invaded axillary artery. The Marjolin's ulcer has a low incidence because of the patient's poor education. The prophylactic attitude is optimal. We favour early excision--grafting of the deep burns, long-term follow-up, excision and grafting of unstable areas (joint area, depigmented regions, chronic ulcers). The optimal surgical technique is excision followed by skin grafting since it allows early detection of the recurrence.

We are presenting a case which had five operations with the central point being the microsurgery. The patient is admitted in our unit 48 ours after sustaining a complex trauma of the left forearm with cvasicomplete destruction of the volar muscles, defects on cubital and radial vasculo-nervous axes and the median nerve. Upon arrival we performed the staged surgical debridement, ligature of the radial and ulnar vessels, anchoring of the ends of the nerves, forearm volar and dorsal fasciotomies, followed by skin grafting. After five months, the grafted skin is replaced by an ipsilateral parascapular free flap. After other three months we repaired the nerves by the mean of sural nerve grafts. The particularity of the case consists in fact that the ulnar nerve, with a longer defect, was reconstructed in a two stage approach. Long-time follow up (one year) shows a very good functional clinical result, confirmed by electromyography. Apart from the clinical challenge, this case confronted us with tactical dilemma. In a case of the facial nerve for the best results the cross-face is performed in two stages. Why shouldn't we do the same thing for all the nerve grafts when we are faced to semnificative defects?

In the treatment of the superficial burns of the hands, since October 1996, we have used exclusively the method of the controlled microclimate, verified in different variants starting early sixties. At the end of the usual primary wound treatment, the hand covered with the chosen topic is an ordinary new polyethylene bag. The bags are not pre-sterilized but the test showed no pathogen germs. The patient uses the hands for the daily activities--eating, reading. He/she is encouraged to perform active exercises (light gymnastics). We change the bags daily or whenever necessary, after a careful of the wound. We evaluated the healing time, the epithelial quality, secretions, mobility, patient's and medical personnel's acceptability, and the economic aspect. Though we couldn't notice a shorter period of healing, the epithelium showed a better quality in the early period of regeneration. The range of mobility was faster restored but long term results were the same as with usual dressings. We consider the method is appropriate for standardization in superficial hand burns in inpatients or outpatients for at least 4 reasons: comfort for the patient, his active and conscious participation in the process of healing, high acceptability among medical personnel, the semnificative economic advantage.

On the basis of 20 observations of tumours of the small bowel a series of diagnostic, therapeutic and prognosis of these lesions are discussed. Malignant tumours of the small bowel (10 adenocarcinomas and 2 sarcomas in the present statistics) represent 1,9 per cent of the total number of malignant tumours of the small bowel. The patients were hospitalized following an acute complication occlusion, haemorrhage, perforation). Four of the patients benefited from a curative treatment, in 5 only a derivation was possible, and in 9 only exploratory laparotomy and bioptic sampling. Eight of the tumours were benign and consisted in : 3 fibromas; 2 neurogenic tumours; 2 adenomatous polyps, and one lipoma. All were discovered in the course of emergency surgery for occluding syndrome or haemorrhage, and benefited from a radical treatment. Two deaths were recorded in the entire series (one following embolism in the 10-th day after surgery and another in the 3-rd day with occluding shock). Both patients were in a condition of severe hydroelectrolytic imbalance.

Between 1950 and 1979 approximately 2400 patients with thyropathies have been operated in the I-st Surgical Clinic of Jassy. Of these 100 had cervico-mediastinal goiters, of which 79 were of the plunging cervico-mediastinal type, 18 were of the mediastino-cervical type and 3 were mediastinal goiters. The surgical treatment was applied in 98 patients, cervicotomy being sufficient to relieve the symptoms in 92 of the cases. The mixed approach (cervicosternotomy, or cervico-thoracic approach) were necessary in 5 cases, and the thoracic approach was selected in one case with an independent posterior mediastinal goiter. The immediate postoperative evolution, as well as the late evolution was good in most of the cases. Postoperative mortality was of 2 percent.

Out of a group of 361 patients with various anatomo-clinical forms of hyperthyroidia--of which 328 had underwent surgery--hospitalized in the Surgical Clinic from Jassy between 1965 and 1974, a total of 17 observations are analised, from the clinical and the therapeutical viewpoint, that showed postoperative thyreotoxicosis crisis. The fact is stressed that the prophylaxis of the crisis is dominated by the principle that no case of hyperthyroidia should be operated on before it has been perfectly balanced from the endocrinological viewpoint. The complex treatment of the cases that are presented included a symptomatic component to which were associated oxygen therapy, tonics, vitamins, hepatotrop preparations, eventually antibiotics. The results obtained--complete recovery in all the cases--can be compared with the best from the literature.

This study is based on a group of 34 primary tumours of the mesenterium which were treated in the first surgical Clinic between 1960 and 1981. In this series were 19 women and 15 men, and the age of the patients varied between 16 and 68 years, being in the average of 44 years. Ten cystic tumours were recorded, and 24 solid tumours. Nine of the tumours were benign and the remaining 25 were malignant. The cystic tumours, for the most of the benign type, were almost exclusively cystic lymphangiomas. One serous cyst was also recorded, as well as one hematic cyst, and one dermoid cyst that had underwent malignization. The solid tumours were all malignant, of the sarcomatous type,, and their starting point was the mesenteral connective-vascular structures. The clinical picture of the mesenteral tumours is polymorphous and non-characteristic. In the frame of paraclinical examinations the radiologic investigation holds an important place and this is especially true for selective arteriography of the upper mesenteric artery, which provides useful informations concerning the topography of the tumour in relation to the mesenteral vascular trunk. Therapeutic possibilities are discussed, and the fact is stressed that, for improving the prognosis an early diagnosis is essential.

With an increasing frequency, recorded by most of the statistics, the thyrotoxicosis of the aged present themselves, most often, under uncharacteristic clinical aspects, often delusive. Out of a series of 37 thyrotoxic patients (representing 9.2% of all cases of thyrotoxicosis admitted to the Ist Surgical Clinic between 1970 and 1980) in 27 cases we performed a the surgical treatmeat with good immediate and late results. As a preliminary, execepting the endocrine balancing the improvement of the respiratory exchanges, the compensation of the possible heart disturbances and the ensurance of a good hydration and restoring of the nutritional state were followed.