Microsurgery in Podiatry

MICROSURGERY is intricate surgery performed using miniaturized instruments and a magnifying instrument, preferably portable such as a variant of Loupes, or a fixed microscope.
In podiatry, such microsurgery is indicated in repair of nerve entrapment, microvasculature repair, and skin-muscle-tendon grafting or repair.
Typically, deep neurovasculature travels together: comitante vein, artery, and nerve. Proper anatomy identification plays a major role in differentiating artery from vein. A surgeon can use several methods, one being the simplest by blocking vasculature flow to the area in question and slowly releasing the flow observing which structure fills back: first artery fills up, then vein in retrograde fashion. This leaves out the nerve.
In a nerve entrapment, scared tissue extends along its tract sometimes strangulating surrounding tissue.
In my future practice and procedures, I will seek an instant identification of nerve structure from surrounding tissue. A simple chemical marker, yet non-reactive to surrounding tissue is in demand. Its application should vary from being injected or simply applied directly in a sterile wash from a dispensing syringe.
The function of the marker is to perform the following: quickly embed within the epineurium of the questionable nerve structure, and become easily visible either by itself or under a specific visible light spectrum, i.e. UV. It is important to realize this nerve identification is non-reactive to surrounding tissue including epineurium. Once the nerve tissue is identified by the protein marker, it is freed from surrounding tissue using microsurgery, and to prevent further scaring, a layer of regenerated tissue matrix is applied along the nerve sheath.
Typically the scar surrounding the nerve is made primarily of collagen fibers, extracellular proteins with triple helical structures making up the fibrillar and microfibrillar network of extracellular matrix. When nerve ending is damaged, the normal extracellular matrix synthesis is up-regulated. It turns out this hinders the regeneration of new nerve sprouts to reach new interface(s). With microsurgery, new avenues of nerve entrapment repair are possible. Currently there is no one single successful procedure. The use of protein epineurium marker as adjuvant procedure should help the successful identification of healthy nerve tissue from surrounding extracellular matrix allowing successful repair without unnecessary damage to healthy nerve tissue.

Made of Stardust

STAR-gazing, such a privilege to ascend into the past of hundreds of million of years ago as projected into our eyes by long lived photon energy.

stargazer |ˈstärˌgāzər|noun informal an astronomer or astrologer.• a daydreamer.

I feel it is far too seldom we find ourselves looking up into the nakedness of the sky above us. I feel we do ourselves a great disservice ignoring our origins.

Late Carl Sagan used to say "We are all made of stardust", billion year old carbon. I can't explain the peace I feel each stargaze I embrace. But I look around and see so many of us busy with lives and the living, and forgetting of the past we used to admire. Up there hangs our dreams, our pasts, and ultimately our future. Stargazing is to some a place of retreat, but always one of comeback.

From the beginning of time, we have always looked up in to the sky to seek comfort or closure from the unknown. In the end, looking up should produce a feeling of both awe and unmatched realization of our puny little existence, the devout symbol of humanity in the face of infinite infinitesimal.