Publications by authors named "Miguel Angel Soto-Miranda"

15 Publications

  • Page 1 of 1

Description and implementation of an ex vivo simulator kit for developing microsurgery skills.

Ann Plast Surg 2014 ;72(6):S208-12

From the *Department of Plastic Surgery, University of Tennessee; and †Department of Plastic Surgery, Baptist Cancer Center, Memphis, TN.

Background: Microsurgical training is an essential part of the plastic surgery training curriculum. Given the emphasis on safety and standardization in surgical training, use of simulators is key. We used a novel microsurgical skills training set to inexpensively, safely, and reproducibly teach and perfect microsurgical skills.

Methods: The microsurgery training set consists of a number of items, including 2- and 3-mm polyvinyl tubes (used to simulate blood vessels), a foam background, and a particulate dye used to test vessel patency after microvascular anastomosis. During a 2-year period, trainees were exposed to the system on at least 3 separate occasions. Qualitative and quantitative performance metrics were recorded at each setting.

Results: Resident performance on the skills exercises improved with each exposure. Composite performance scores and completion times correlated significantly with the number of microsurgical cases each resident performed (P < 0.05). Utilization of the system was positively received by trainees on posttraining interviews.

Conclusions: On the basis of our experience, this system is a cost-effective way to introduce trainees to microsurgical skills. Furthermore, performance on the skills trainer positively correlates with actual microsurgical experience. Use of this system is a valuable alternative, compared to animal-based skills laboratories. Its use as a metric to establish competence in microsurgical skills acquisition is described.
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http://dx.doi.org/10.1097/SAP.0000000000000095DOI Listing
January 2015

Gluteal lift with subfascial implants.

Aesthetic Plast Surg 2013 Jun 13;37(3):521-8. Epub 2013 Apr 13.

Institute for Plastic Surgery, Vialidad de la Barranca S/N, Huixquilucan, Estado de Mexico, Mexico.

Background: Gluteal enhancement surgery includes buttock implants, gluteal flaps, lipografting, and gluteal lifts. However, no information is available on the outcomes achievable using the gluteal lift combined with subfascial gluteal implants.

Methods: A retrospective study was performed to analyze the outcomes of gluteal lift combined with subfascial gluteal implants performed during a 7-year period by a single surgeon at a single institution.

Results: During the study period, 114 patients (228 implants) ages 27-68 years (mean 47 years) were found. The follow-up period was 1-7 years (mean 4.5 years). The findings showed seroma in 11.4 % of the patients, hematoma in 5.26 %, minor wound dehiscence in 19.29 %, major wound dehiscence in 1.75 %, minor infection in 1.75 %, implant exposure in 0 %, capsular contracture Becker 3 and 4 in 3.5 %, implant rupture in 0 %, implant malposition in 5.25 %, long-term numbness of the buttock in 0 %, palpability of the implant in 0 %, implant rippling in 0 %, implant rupture in 0 %, wide scars in 41.2 %, need for secondary surgery in 26.31 %, and dissatisfaction with the final volume in 10.52 %. A patient satisfaction rate of 9.6 in 10 was found.

Conclusions: The study showed that the gluteal lift combined with gluteal implants placed in the subfascial pocket provided good long-lasting results with an acceptable rate of complications, very high patient satisfaction, and easily concealed scars.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-013-0108-2DOI Listing
June 2013

Ultrasonically assisted face-lift.

Aesthetic Plast Surg 2012 Aug 23;36(4):780-7. Epub 2012 Mar 23.

Institute for Plastic Surgery, Vialidad de la Barranca S/N, 52763, Huixquilucan, Estado de Mexico, Mexico.

Background: The face-lift procedure is one of the most skillful interventions performed by plastic surgeons. Ultrasonic energy is used to elevate the facial skin flap, which allows for preservation of vascular, lymphatic, and nervous structures, thereby decreasing the morbidity associated with this procedure.

Methods: A retrospective study to compare the outcomes of ultrasound and non-ultrasound-assisted face-lifts is reported. All the procedures were performed at the Institute for Plastic Surgery. Each group consisted of 104 patients. Statistical analysis was performed to determine differences between the groups.

Results: The mean operating time was 4 h in the treatment group versus 4.2 h in the control group (p>0.05). The incidence of hematoma formation was 0.96% in the treatment group versus 2.4% in the control group (p<0.05). The incidence of flap necrosis was 0% in both groups. The duration of ecchymosis was 13 days in the experimental group versus 17.2 days in the control group (p<0.05). The duration of postoperative swelling was 17.4 days in the treatment group versus 20.4 days in the control group (p<0.05). As reported, 85% of patients in the treatment group were very satisfied, 14.42% were satisfied, 0% were mildly satisfied, and 0% were not satisfied. In the control group, 80.7% were very satisfied, 18.26% were satisfied, 0.96% were mildly satisfied, and 0% were not satisfied. According to Fisher's exact test, the p value for patient satisfaction exceeded 0.05%.

Conclusions: The preservation of the blood and lymphatic vessels diminishes postoperative swelling and shortens the duration of ecchymosis considerably. The incidence of hematoma formation is lower than with a non-ultrasonic face-lift. This study failed to prove any statistically significant difference in operating time or patient satisfaction between the two groups.
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http://dx.doi.org/10.1007/s00266-012-9880-7DOI Listing
August 2012

The survival curve: factors impacting the outcome of free flap take-backs.

Plast Reconstr Surg 2012 Jul;130(1):105-113

Houston, Texas From Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.

Background: When vascular compromise is detected, a free flap is immediately taken back to the operating room for attempted salvage. Which factors predict the success or failure of a take-back is currently unknown.

Methods: A review of free flaps performed at a single institution over the last 10 years was performed. A total of 4965 flaps were identified, and an analysis of factors predicting salvage or failure of first, second, and third take-backs for microvascular complications was performed.

Results: Of 4965 flaps, 517 (10.3 percent) required return to the operating room, 157 (3.34 percent) for vascular complications. There were 66 (1.41 percent) total flap failures. Of 157 take-backs, 102 required return once, 44 twice, and 11 three times, with salvage rates of 72, 34, and 27 percent, respectively (p < 0.01). Overall salvage rate was 58 percent. The probability of a flap going back for a second time was 35 percent. Risks for flap failure included thrombotic (35.1 percent) versus mechanical (8 percent) etiology (p = 0.01) and arterial (37.5 percent) or mixed (61.5 percent) versus venous only (25 percent) etiology (p = 0.06). Failure was more likely the greater number of days postoperatively the take-back occurred (p = 0.02).

Conclusions: The number of returns to the operating room is inversely proportional to flap salvage. Mechanical and venous etiologies tend to result in salvage and arterial and thrombotic etiologies in failure. Earlier take-backs are more likely to be successful. Knowledge of these predictors of salvage should guide clinical decision making and informed consent.

Clinical Question/level Of Evidence: Risk, II.
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http://dx.doi.org/10.1097/PRS.0b013e318254b1b9DOI Listing
July 2012

Intranasal surgical approach for malar alloplastic augmentation.

Aesthet Surg J 2012 Jan;32(1):27-38

Institute for Plastic Surgery, Mexico City, Mexico.

Background: Alloplastic malar augmentation is becoming an increasingly common procedure for enhancement of the midface and an adjunct method of improving the effects of other rejuvenation procedures.

Objectives: The authors present a new surgical approach for placement of malar implants by means of an intranasal incision, which they believe has several advantages over traditional techniques. They also propose a new classification for regions of the midface to assist in augmentation planning.

Methods: Between 1990 and 2010, the authors treated 20 patients with an intranasal approach for alloplastic malar augmentation. Patients were preoperatively divided into three groups: Type 1 included those with adequate nostril opening, including good elasticity of the internal nasal mucosa, allowing a good exposure of the piriform aperture through the nasal speculum; Type 2a included those with inadequate nostril opening; and Type 2b included those who required an alar base correction. Implants were selected according to these classifications and placed with the authors' technique.

Results: Of the 20 patients treated, 18 were female and two were male. Ages ranged from 15 to 65 years. Average follow-up was 10 years, and all patients experienced favorable results. There were no major complications, no nerve or vascular supply compromise, and no cases of implant malposition. One patient requested removal of the implant at one year postoperatively despite her good postoperative outcome; overall patient satisfaction was 95%.

Conclusions: The intranasal approach for alloplastic malar augmentation has shown good results for midface enhancement in the authors' hands. In this patient series, results showed excellent overall patient satisfaction and a very low (nearly 0%) complication rate.
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http://dx.doi.org/10.1177/1090820X11430498DOI Listing
January 2012

Back to the future: a 15-year experience with polyurethane foam-covered breast implants using the partial-subfascial technique.

Aesthetic Plast Surg 2012 Apr 17;36(2):331-8. Epub 2011 Dec 17.

Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, Huixquilucan, 52763, Mexico.

Background: Implants with a polyurethane foam cover have been used by plastic surgeons since Ashley described them in 1970. Overwhelming evidence confirms the benefits of these implants, especially the extremely low incidence of capsular contracture (grades 3 and 4, Baker classification). On the other hand, except for a transient and self-limited rash, there is no evidence that polyurethane implants present more complications than texturized or smooth gel implants. Due to concerns of polyurethane-induced cancer, these implants were withdrawn in United States after approximately 110,000 American women had received them. This fact, together with the probability that these implants will be reintroduced in the United States, suggests that continued monitoring of their long-term safety and effectiveness is mandatory.

Methods: A retrospective study analyzed the outcomes of 996 implants inserted during a period of 15 years. The incidence of early and late complications was analyzed as well as the aesthetic outcome.

Results: The complications evaluated included hematoma (0.6%), infection (0.4%), seroma (0.8%), rash (4.3%), wound dehiscence (0%), capsular contracture (0.4%), implant malposition (0.8%), need for revisional surgery (1.2%), implant rupture (0.7%), rippling (1.8%), and polyurethane-related cancer (0%). Regarding the aesthetic outcome, 95% of the patients expressed satisfaction with their final result.

Conclusion: The polyurethane foam-covered implants have been proven safe for use in breast surgery. They provide the lowest rate of capsular contracture (0.4% in the current study) and excellent aesthetic results.
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http://dx.doi.org/10.1007/s00266-011-9826-5DOI Listing
April 2012

Calf implants: a 25-year experience and an anatomical review.

Aesthetic Plast Surg 2012 Apr 30;36(2):261-70. Epub 2011 Sep 30.

Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, 52763, Huixquilucan, Mexico, Mexico.

Background: Body contouring in the calf region is becoming a more frequently requested procedure. There are several techniques for calf enhancement, including implants, liposuction, and free flaps. Alloplastic augmentation can be performed with several implant types and several layers of pocket dissection. We present our 25 years of experience using the subfascial technique for calf implantation along with an anatomical study to illustrate all the important steps and relevant anatomy of this augmentation technique.

Methods: The subfascial technique was performed in 25 cadavers, in which the important layers were dissected for high-resolution photos of the surgery to learn about the relevant anatomy of the region. Also, we did a retrospective study of our experience with calf implants, studying the aesthetic outcome, the presence of early complications, and the presence of late complications.

Results: We performed dissections in 25 cadavers and surgery in 63 patients (126 implants). In our series of patients the final aesthetic index was of 9.8. The early complications were severe postoperative pain (11.11%), infection (0.79%), seroma (21.42%), hematoma (0%), and wound dehiscence (7.14%). The late complications were capsular contracture (Baker grades III and IV) (3.17%), implant rupture (1.58%), implant leaking (0%), implant displacement (3.96%), numbness at the ankle (2.38%), and palpability of the implant (0%).

Conclusion: The subfascial technique for calf augmentation has complication rates low enough and surgical outcomes good enough to recommend it as the gold standard for alloplastic calf augmentation.
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http://dx.doi.org/10.1007/s00266-011-9812-yDOI Listing
April 2012

Prophylactic mastectomy: is it worth it?

Aesthetic Plast Surg 2012 Feb 13;36(1):140-8. Epub 2011 Jul 13.

Institute for Plastic Surgery, Vialidad de la Barranca S/N, office 490, Huixquilucan, 52763, Mexico.

Background: Breast cancer is the second mortality-related cancer and the leading cause of general mortality in women aged 40-55. Prophylactic mastectomy has proved to be effective in several clinical scenarios but is still a somewhat controversial procedure.

Methods: We performed a retrospective study by reviewing the records of all patients who underwent prophylactic mastectomy in a 25-year period. We evaluated the aesthetic and long-term oncologic outcomes, complications, and patient satisfaction.

Results: We had 52 patients, 40 of them unilateral cases (contralateral prophylactic mastectomy) and 12 bilateral (bilateral prophylactic mastectomy) for a total of 64 mastectomized breasts. We had 1 (1.56%) case of unexpected breast cancer in the mastectomy specimens. Forty-two (65.62%) cases had a subcutaneous prophylactic mastectomy and 22 (34.37%) cases had a simple total prophylactic mastectomy. Fifty-eight (90.62%) cases underwent reconstruction with alloplastics and 6 (9.37) cases with autologous tissue of which 5 (7.81%) cases received latissimus dorsi flaps with alloplastic implants and 1 (1.56%) case had a TRAM flap. The complications included 4 (6.25%) breasts that developed capsular contracture, 2 (3.12%) cases of hematoma, and 1 (1.56%) infection. Concerning patient satisfaction, 39 (75%) patients reported being highly satisfied, 10 (19.23%) partially satisfied, and 3 (5.76%) unsatisfied. When we performed the aesthetic evaluation according to our scale, we got an overall aesthetic index of 8.8.

Conclusion: Prophylactic mastectomy is becoming an increasingly frequent procedure. Plastic surgeons should consider the aesthetic outcome when planning mastectomy and reconstruction. Our ability to predict the high-risk population has improved and it is that population who can get the best benefit from this intervention. The recommendation against subcutaneous prophylactic mastectomy lacks scientific evidence. There is plenty of evidence that prophylactic mastectomy lowers the risk of breast cancer in the high-risk population in at least 95%. Our experience with prophylactic mastectomy is extremely satisfactory, with an overall patient satisfaction rate of 94%, no mortality, and an oncologic long-term outcome of 0% of ulterior development of breast cancer. Our series, although relatively small, should provide some insight into the power of this technique and we think all plastic surgeons should have it in their surgical armamentarium and should share their experiences so that this procedure may become more widely accepted. We also think that plastic surgeons should strive for perfecting the technique to reduce the complication rate and therefore help the procedure gain acceptance by the medical community.
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http://dx.doi.org/10.1007/s00266-011-9769-xDOI Listing
February 2012

Treatment protocol for "Mestizo nose" with open rhinoplasty.

Aesthetic Plast Surg 2011 Dec 2;35(6):972-88. Epub 2011 May 2.

Institute for Plastic Surgery, Vialidad de la Barranca S/N, Huixquilucan, Estado de Mexico, Mexico, Mexico.

Background: The aim of this study was to develop an operative sequence to guide plastic surgeons on how to handle the challenges of "Mestizo nose" during rhinoplasty. This type of nose has characteristics quite different from the Caucasian nose. Rhinoplasties on Mestizo nose represent a surgical challenge because of the anatomical characteristics of a weak frame and thick skin. The Hispanic population has grown, and nowadays a large number of patients requesting rhinoplasty within the US belong to this ethnic group.

Methods: We have developed an operative sequence for the treatment of Mestizo nose. This operative sequence has been tested in 879 rhinoplasties (92.37% females and 7.62% males, aged 15-63 years, mean age = 39 years). All were primary cases. An algorithm on how to approach the different types of Mestizo nose is presented.

Results: We had overall good results using our algorithm, with an improvement in the nasal aesthetics of about 54.75%. Complications were postoperative bleeding (1.37%), pain (0.57%), septal hematoma (0.23%), unaesthetic scars (0.34%), and cartilage extrusion (0.11%). Our revision rate was 5%. We present ten complete cases to show our surgical results.

Conclusion: This operative sequence has allowed us to get predictable and reliable surgical outcomes when used in Mestizo rhinoplasty operations. We think it can be very useful for every plastic surgeon who performs Mestizo nose rhinoplasty, although not all steps need to be performed in every case.
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http://dx.doi.org/10.1007/s00266-011-9717-9DOI Listing
December 2011

[Penile calciphylaxis: case report and literature review].

Cir Cir 2007 Mar-Apr;75(2):113-7

Departamento de Cirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Associación Mexicana de Cirugía General.

Background: Calciphylaxis is a serious condition characterized by ischemic ulceration of the skin and necrosis secondary to dystrophic calcification of the subcutaneous tissue and small arteries. It affects primarily patients with end-stage renal disease with prevalence up to 4%. However, penile calciphylaxis has been reported in only 37 cases in the international literature. We report one case, to review the literature and to provide the basis for a rational treatment of calciphylaxis of the penis that reduces the associated mortality.

Case Report: We report the case of an 82-year-old male with a 15-year history of type 2 diabetes mellitus and renal insufficiency during the past 2 years. He presented an increase of consistency of the distal portion in the penis' glans and scrotal swelling, evolving to complete penile glans necrosis.

Conclusions: With the increase of the number of patients on dialysis treatment, the prevalence of calciphylaxis will increase. A high index of suspicion is warranted in all patients with end-stage renal disease and who present the characteristic genital lesions. Treatment of this complication must include avoidance of all exogenous calcium, administration of calcitriol analogues to offset the PTH, emergency parathyroidectomy in the case of overt hyperparathyroidism and aggressive surgical treatment with total or partial penectomy.
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October 2007

[Distinguished doctors of the University of Padua and their works: 16th to 18th centuries].

Cir Cir 2007 Jan-Feb;75(1):57-61

Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, 09090 México, D.F., Mexico.

Italian universities have been distinguished since their beginnings, within different specialties. One of them, if not the most important, is the teaching of medicine. One of the leaders is the University of Padua, founded in 1222, establishing itself as the second most important institution after the University of Bologna. In spite of the difficulties faced by this university, as with most other universities during the medieval period, it continued to perform and consolidate once again during the Renaissance as one of the most outstanding universities in Europe. The University of Bologna and the University of Padua shared the leadership in teaching during this period. At the University of Padua, the lectures were always full with teachers and students of great fame, such as Andreas Vesalio, Gabriele Falopio, William Harvey, Giovanni Battista Morgagni, Antonio Scarpa, to name just a few. In this article we discuss the rights the University had since it beginnings, from its establishment to the Renaissance, and the great influence of some of the teachers and students in the art and science of medicine.
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April 2009

[Foundation and organization of the University of Bologna from the XII century to the Renaissance].

Cir Cir 2006 Sep-Oct;74(5):397-404

Departamento de Cirugía, Universidad Nacional Autónoma de México, México.

The University of Bologna was founded in 1150 and was the first European University to establish this educational trend. The combination of structured teaching and student associations marked the origin of the studium generale. The presence of teaching legists encouraged teachers in others fields to come to Bologna. Ars dictaminis, grammar, logic, philosophy, mathematics and especially medicine were taught there by the middle of the thirteenth century. The university offered advanced instruction in law, medicine, and theology and had a minimum of six to eight professors teaching civil law, canonical law, medicine, logic, natural philosophy and usually rhetoric. Many professors bearing local names were learned scholars and commanding figures in medicine and surgery. Taddeo Alderotti (1210-1295) began to teach medicine in Bologna in about 1260. He soon raised medicine to a prestigious position in the university. The geographical distribution demonstrates the international distribution of the student body: 73% were Italians and 26% non-Italians. The decision of the legislature of Bologna to take control of the university from the students by paying professors was probably the most important decision in the history of Italian universities. Examination of the distribution of professors offers a detailed picture of the faculty. In 1370 the university had 11 professors of civil law, 7 professors of canonical law, 3 professors of medical theory, 2 professors of medical practice (specifically of diagnosis and treatment), and 1 professor of surgery. After growing steadily, the numbers of teachers stabilized at 85 to 110 until the year 1530.
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April 2007

[Tagliacozzi: not just a plastic surgeon].

Gac Med Mex 2006 Sep-Oct;142(5):423-9

Departamento de Cirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D. F., México.

Gaspare Tagliacozzi is known because of his great contributions to plastic surgery. He is considered a pioneer in the field, which has had more influence in his career than his other transcendental activity as a surgery and anatomy teacher in Bologna for almost 30 years. The aim of the present manuscript is to analyze his teaching activities which were equally important for us, and to recreate, with pictorial means, three unpublished historic moments in the life of this great man of science. Gaspare Tagliacozzi was born in Bologna in 1545 and is considered the father of plastic surgery. He obtained a degree in medicine and philosophy at the University. He was named surgery professor in 1576, and worked as such until his death in 1599. His De Curtorum Chirurgia per Insitionem treatise was published in 1589 and was considered the first exclusive treatise on plastic surgery. Bologna built a permanent operating theater (amphitheater) within the Archiginnasio in 1595. Because of his success, he increased his earnings; his first university teaching salary was 100 lire, but his earning increased to 1,140 lire later. Tagliacozzi's contributions, together with that of others such as Vesalius, Aldrovandi, Fallopian and Eustachian advanced the field and knowledge of anatomy.
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December 2006

[Teaching of medicine of the University of Bologna in the Reinaissance].

Rev Invest Clin 2006 Mar-Apr;58(2):170-6

Departamento de Cirugía, Facultad de Medicina, UNAM.

The foundation date of the University of Bologna was 1150, was the first European University and set the pattern. The combination of structured teaching and students association marked the origin of the studium generale. The presence of teaching legists encouraged teachers in others fields to come to Bologna. Ars dictaminis, grammar, logic, philosophy, mathematical arts and especially medicine were taught there by the middle of the thirteenth century. The university had to offer advanced instruction in law, medicine, and theology, had a minimum of six to eight professors teaching civil law, canon law, medicine, logic, natural philosophy and usually rhetoric. Many professors bearing local names were able scholars and commanding figures in medicine and surgery. Taddeo Alderotti (1210-95) began to teach medicine in Bologna about 1260. He soon raised medicine to a prestigious position in the university. The geographical distribution demonstrates the international character of the student body 73% were Italians and 26% non Italians. The decision of the commune of Bologna to wrest control of the university from the students by paying professors was probably the most important decision in the history of Italian universities. Examination of the distribution of professors offers a detailed picture of the faculty. In 1370 the university had 11 professors of civil law, seven professors of canon law, three professors of medical theory, two of medical practice (the specific of diagnosis and treatment), and one professor of surgery. After growing steadily the numbers of teachers stabilized at 85 to 110 until 1530.
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November 2006

[Surgery and anatomy in the Renaissance].

Cir Cir 2005 Mar-Apr;73(2):151-8

Hospital de Especialidades del Centro Médico Nacional La Raza, IMSS, Mexico.

The interest in the physical perfection and the corporal forms brings as a result the creation of new anatomical studies. The anatomical knowledge progressed in the second half of the XV century, conceiving the knowledge of the human body as a basic reality of Medicine. One of the greater contributions of the Italian Universities to medicine was the teaching of anatomy. The Universities of Padua, Bologna, and Pisa educated in their classrooms great physicians like Andres Vesalio, Gabriel Fallopio, Realdo Colombo, Mondino de Luzzi, Julio Ceasar Aranzio, and Gaspare Tagliacozzi, among others. The teaching of anatomy during the Renaissance was characterized by the development of dissection techniques and autopsy practice, which was recognized as an extremely valuable skill for anatomical study. The dissections were made in circular amphitheatres in the following way: a Medicine professor read the text book, another one made the dissection, and a third one indicated the structures referred.
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October 2005
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