Excision of the cyst and, if necessary, reconstructive coverage.

Conventional circumcision techniques may result in bleeding, limited control of the mucosal collar, and the need for dressings. We describe a modified bipolar technique enabling near-bloodless dissection with precise mucosal trimming. Following bipolar division of the preputial skin, the inner mucosa is separated using two forceps and retracted proximally, creating a protective plane for safe skin adjustment. The mucosal collar is trimmed with scissors. The wound is closed with sutures and 2-octyl cyanoacrylate, avoiding dressings. This technique has been performed in 55 consecutive cases (median age: 2 years and 2 months; range: 0 days-17 years and 5 months) with no reported complications over a median follow-up of 2 years and 7 months (range: 3 months-4 years and 1 month).

Efficient management of surgical instruments is a critical component of operating room safety and workflow reliability. In routine clinical practice, inconsistent instrument placement and reliance on manual counting impose a substantial cognitive and operational burden on surgical teams, increasing the risk of preventable intraoperative errors. To address these challenges, we propose a vision-based deep learning framework to support standardized management of surgical instrument tables through real-time monitoring of instrument presence and usage. The framework integrates dedicated modules for instrument table segmentation, instrument recognition, and hand activity tracking, enabling continuous analysis of intraoperative video streams. In comparative evaluations, the proposed segmentation module achieved a mean accuracy of 94.95% and a mean intersection-over-union of 90.04%, while the instrument recognition module reached a mean accuracy of 98.5% with a precision of 97.59%, outperforming existing approaches under the same experimental conditions. Based on this framework, an initial system prototype was developed and evaluated in a simplified simulated environment involving four representative and routinely used surgical instruments (surgical scissors, forceps, occlusive dressings, and a kidney dish). The results demonstrate the technical feasibility of using computer vision-based systems to support standardized instrument placement and real-time counting in the operating room. Rather than replacing clinical judgment, the proposed approach is intended to function as an assistive tool that complements existing workflows. By reducing manual workload and supporting more reliable instrument management, this framework has the potential to enhance operating room safety and efficiency, with broader implications for risk reduction and operational performance in surgical care settings.

BACKGROUND: Clinical skills training in surgical clerkships relies heavily on faculty supervision, yet traditional models often face time constraints, lack of individualized guidance, and the inability to provide timely feedback. Technology-enhanced, learner-centred approaches, such as video-based self-directed systems, may help address these limitations. The Self-directed Teaching System (SDTS) integrates multi-angle video recording, self-paced practice, and structured feedback to support autonomous learning, but its effectiveness compared with that of conventional instructor-led teaching remains unclear. OBJECTIVE: This randomized controlled trial aimed to (1) evaluate the effectiveness and efficiency of SDTS versus traditional teaching in training basic surgical skills and (2) compare three SDTS feedback modalities (self-, peer-, and instructor-feedback) in influencing learning outcomes. METHODS: Sixty-two surgical interns were randomized to either a traditional teaching group (fixed 3-hour session with real-time faculty guidance) or an SDTS group (self-directed practice with multi-angle video recording and delayed feedback). Within the SDTS arm, participants were further randomized into self-feedback (n = 10), peer-feedback (n = 10), or instructor-feedback (n = 11) subgroups. All students completed pre- and post-training Objective Structured Clinical Examinations (OSCEs) on two skills: incision/suturing and suture removal/dressing change. Total training duration for the SDTS group, including video learning, practice, and feedback activities, was logged through the backend system data. RESULTS: Fifty-six interns completed the full protocol. For incision and suturing, SDTS shows no statistical difference compared with traditional teaching (P > 0.05). However, for suture removal/dressing change, a more complex, step-intensive procedure, the traditional group scored significantly higher than SDTS group (P < 0.05). Despite this, SDTS participants required substantially less total training time in both modules. The three SDTS feedback subgroups demonstrated no statistical differences in post-training OSCE performance. Learners reported high levels of satisfaction with the video-based feedback process and perceived improvement in procedural skills. CONCLUSIONS: The SDTS provides a flexible, technology-supported approach to surgical skills training and can deliver learning outcomes comparable to traditional methods for basic procedures while enabling more flexible use of training time. However, for more complex tasks, fully self-regulated practice without the required minimum training time may risk premature disengagement, before participants could fully refine their skills. While the feedback modality did not significantly impact outcomes, studies with a larger sample size are needed to verify subgroup effects. The SDTS shows strong potential as a scalable, learner-centred model for clinical education.

This systematic review analyzes postoperative complications at the palatal donor site following the harvesting of autologous soft tissue grafts in periodontal surgery. Although these grafts remain the clinical reference standard due to their effectiveness, their harvesting may be associated with donor-site morbidity, including pain, bleeding, partial necrosis, and sensory disturbances. A comprehensive search was conducted in PubMed, Scopus, and Web of Science, identifying 16 clinical studies published between 2019 and April 2025. The included studies comprised randomized controlled trials, prospective and retrospective clinical studies, and case series, with sample sizes ranging from 6 to 89 participants. Due to heterogeneity in study designs, outcome measures, and follow-up protocols, a qualitative synthesis was performed and a quantitative meta-analysis was not feasible. Postoperative pain was the most frequently reported complication and was commonly assessed using the Visual Analog Scale (VAS), although other instruments such as the Numeric Rating Scale (NRS) were also used. Several adjunctive strategies, including palatal stents, hyaluronic acid, platelet-rich fibrin (PRF), mucoadhesive dressings, and low-level laser therapy (LLLT), were reported to be associated with lower postoperative discomfort and favorable healing patterns. Bleeding was reported less frequently and was generally self-limiting, particularly when local hemostatic measures were applied. Sensory disturbances were typically mild and transient, resolving during routine follow-up. No serious infections or complications compromising patient health were reported. In conclusion, while morbidity at the palatal donor site is relatively common, it is generally mild and manageable. Certain adjunctive measures may help reduce postoperative discomfort and support healing; however, the overall strength of the available evidence remains moderate. These findings may help improve postoperative recovery and inform future clinical research.

OBJECTIVE: Severe hemorrhage is one of the predominant causes of death among trauma patients. Conventional techniques often prove insufficient for hemostasis in junctional injuries. Therefore, this study independently developed a disposable sterile hemostatic clamp. Swine groin models were utilized to evaluate its efficacy. METHODS: 10 healthy Bama Xiang boars aged 6–7 months were divided to two groups. After femoral artery incision, the control group were treated with bandages and the experimental group were treated with hemostatic clamps. The survival rate, survival time, hemostatic operation time, and blood loss were recorded. Local joints were repeatedly flexed to assess the stability of the hemostatic clamp. Physiological parameters were monitored and recorded. Ultrasound was used to observe blood flow perfusion. Local skin was examined and femoral arteries were taken for pathological staining. RESULTS: In experimental group and control group, all 5 (100%) and 3 (60%) animals survived, respectively. The survival time of experimental group was all > 180 min, the median survival time and interquartile range of control group were 180 min and 68 min. The hemostatic procedures time were 22.50 ± 2.89 min and 57.25 ± 13.60 min, and blood loss were 190 ± 100 g and 549 ± 195 g, respectively. Ultrasound showed the clamp effectively reduced distal arterial blood flow. It was well-fixed after joint movement, while bandages were loose. No skin damage was observed. Femoral arteries in experimental group showed intravascular thrombosis, while no thrombosis was oberserved in control. CONCLUSION: Compared to traditional bandaging, the hemostatic clamp may help to reduce blood loss and stabilize vital signs, demonstrating its potential in controlling severe pre-hospital hemorrhage.

The development of modern first aid around the year 1900 was intricately connected to industrial standardization, bacteriological advancements, and the dissemination of global medical knowledge. This study examines the material culture of military first aid in high-altitude warfare during the First World War, utilizing a first aid kit from the Imperial-Royal Landwehr documented in the Ortler region (South Tyrol). The research integrates object analysis, comparison with manufacturer catalogues and international first aid kits from the era, and historical contextualization. The first aid kit exhibits a distinctly functional modular design, incorporating traditional dressing materials alongside various antiseptic preparations, standardized aseptic dressings, and more sophisticated instruments for medical interventions. Of particular significance are an industrial kit for drinking water disinfection (Bayer, Leverkusen) and an injection kit with antivenin according to Calmette (Pasteur Institute), which highlight prophylactic hygienic and colonial medicine dimensions. This discovery indicates that first aid in a military context had evolved beyond mere emergency surgical care to encompass a preventive strategy aimed at epidemic prevention and the integration of global innovations into the regional theater of war.

Seymour fractures are open, distal phalangeal physeal fractures with an associated nail-bed injury that occur in pediatric patients[1]. Although first described in the finger, an equivalent injury can occur in the distal phalanx of the great toe, often via a direct axial load at the apex of the toe, resulting in Salter-Harris type-I or II or juxta-epiphyseal fractures with a concomitant nail-bed laceration[2-12]. Closed reduction and splinting were initially recommended in these fractures[1]; however, they are now commonly treated with formal irrigation and debridement and the administration of prophylactic antibiotics in the acute setting in order to minimize the risk of complications such as infection[10-12]. To our knowledge, there are no detailed resources describing this surgical technique.

Seymour fractures are a unique type of pediatric distal phalangeal fracture that can be easily misdiagnosed as a simple nail-bed injury or mallet finger[1-3]. Because of this potential for misdiagnosis, clear communication with consulting physicians regarding physical examination findings, such as nail plate avulsion and radiographic findings, is necessary. Seymour fractures involve the open physis and the germinal matrix, which become interposed in the fracture site, increasing the likelihood of infection. Open fractures are often displaced as a result of the distracting forces of the extensor and flexor tendons. This displacement, combined with the frequent association of nail bed lacerations, creates a high risk of complications such as infection and nonunion[1-3]. If left untreated or inadequately treated, these complications can lead to further surgery, prolonged antibiotic use, and potentially long-term impairment of hand function and cosmesis.

Bacterial biofilms in chronic wounds establish drug-impermeable barriers through extracellular polymeric substance (EPS) matrix formation. Versus surgical debridement and systemic approaches, microneedle systems have evolved as minimally invasive platforms exhibiting marked progress in biofilm management. Microneedles enhance contact area with bacterial biofilms by >13.74% versus traditional wound dressings, improving treatment outcomes. This review systematically examines recent therapeutic innovations in microneedle-mediated biofilm intervention between 2018 and 2025. Firstly, this paper systematically reviews the action mechanisms of solid, coated, hollow, soluble, and hydrogel microneedles against bacterial biofilms. It then discuss the advanced fabrication methods for antibiofilm systems. Antimicrobial mechanisms are innovatively classified into three modalities, physical disruption, chemical targeting, and bioactive regulation. The following sections present preclinical applications corresponding to each mechanistic category. These results provide a roadmap for clinical translation of microneedle antimicrobial technologies.

Serratia marcescens (S. marcescens) is a common bacterial species isolated from patients' specimens. Medical equipment like catheters, cannulas, tubing, dressing materials, and surgical instruments can become colonized by S. marcescens. Critically sick patients are the main victims, especially those in intensive care units or surgical settings where extended hospital stays and the use of broad-spectrum antibiotics are typical. Although S. marcescens is commonly linked to bloodstream infections, respiratory tract infections, and urinary tract infections, it is comparatively uncommon to be involved in wound infections following surgery. We describe a rare instance of a soft tissue infection brought on by S. marcescens at the location of the abdominal wall where autologous bone flaps were temporarily stored after a decompressive craniectomy. The patient had symptoms of a localized infection, which led to further evaluation and targeted therapy. Culture and antibiotic sensitivity tests guided the selection of drug therapy. This case demonstrates the unusual way that S. marcescens manifests in soft tissue infections following neurosurgery, emphasizing how crucial it is to follow strict aseptic procedures, particularly when working with surgical bone flaps. Knowledge of these atypical organisms is crucial for timely diagnosis and effective treatment, especially in critical care and postoperative settings.