bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment and management of thrombotic complications
Authors: Noble Simon , Pease Nicola , Chinn-Yee Nicolas
Published: September 2021

Venous thromboembolism (VTE) is a common complication of cancer and its treatments and may confer a significant symptom burden on patients. Sometimes such symptoms are attributed to other cancer-associated pathologies and may thereby go undiagnosed as a VTE and not be treated. Rather than being one single entity, cancer-associated thrombosis (CAT) is a highly heterogeneous phenomenon which will vary with primary cancer, stage, and treatment regimen. The treatment of CAT has many challenges since anticoagulation is often associated with a high rate of VTE recurrence and bleeding. While there are several classes of anticoagulants currently available, each have their perceived benefits and downsides. These become more complex with disease progression with little robust data to inform management in the advanced cancer population and at the end of life. Furthermore, a significant proportion of patients seen by specialist palliative care teams comprise a population who were excluded from the major CAT trials. It is common to encounter cases where the evidence is lacking, such as recurrent VTE, thrombocytopenia, and bleeding. Other challenges and uncertainties lie with the role of VTE prevention in hospices and specialist palliative care units, where patients are highly thrombotic but the benefits or risks of thromboprophylaxis are unclear. This chapter presents the most up-to-date data pertaining to the treatment and prevention of CAT with particular emphasis on patients nearing the end of life.
Advanced diseases of the lung
Authors: Smallwood Natasha , Goh Nicole
Published: September 2021

Advanced, non-malignant, respiratory diseases such as chronic obstructive pulmonary disease and the interstitial lung diseases lead to significant morbidity and mortality globally. Patients with these conditions frequently have a significant and sustained symptom burden, unrelenting psychosocial effects, and significant information and communication needs. While management of these conditions has traditionally focused on disease-directed therapies, there is increasing awareness that patients with these conditions and their carers also need access to palliative care. Importantly, palliative care should be considered as complementary to disease-directed care, with both occurring concurrently. However, few patients with chronic obstructive pulmonary disease or interstitial lung disease access either symptom palliation or palliative care services. Thus, it is essential that not only palliative care clinicians, but also primary care and respiratory medicine health professionals have competence and confidence to offer a palliative approach in addition to disease-directed management to their patients. Integrated respiratory and palliative care services offer promise and may overcome some of the barriers which prevent patients with advanced, non-malignant, respiratory diseases accessing palliative care, while also fostering collaboration and bidirectional education between the two disciplines.
End-stage kidney disease
Authors: Murtagh Fliss E. M.
Published: September 2021

End-stage kidney disease accounts for 1–2% of all deaths. With ageing of the population, this proportion will grow steadily over the coming years. Symptom burden in end-stage kidney disease exceeds advanced cancer, with added renal-specific symptoms, such as itch and restless legs. Pain and depression are also more prevalent. Many renal symptoms go under-recognized and undertreated, especially as they arise from comorbid conditions, rather than the renal disease itself. The most useful intervention to address symptoms is regular assessment, followed by pharmacological interventions that take account of the constraints on using renally cleared drugs and the high risk of toxicity from accumulation of parent compounds or metabolites. The population with end-stage kidney disease have extensive palliative care needs, and require significant medical, nursing, psychological, and social care to address these as their illness advances towards the end of life.
Involving children and families when someone important is dying or has died
Authors: Haraldsdottir Erna , Paul Sally
Published: September 2021

The untimely death of a close family member is one of the most challenging events for families including children. This chapter discusses how a basic knowledge of child development and the ways that children understand illness and death can provide a template from which to inform families about how to help their children during this time and into bereavement. It addresses such topics as how children understand death at different ages, timing of discussions with children, decisions about the setting for end of life care and death in a family context, visiting the ill person, legacy leaving, and children’s participation in funerals and memorial services. By supporting families to anticipate common situations and questions, health and social care professionals can work with surviving adults to use their own (and the child’s) resources to provide thoughtful and meaningful care for children during this difficult time. This support encourages adults to include and involve children, using honest, child-centred communication during the illness period, at the end of life phase, at the time of death, and after death. Such communication is crucial for ongoing bereavement and family functioning.
Care of children with advanced illness
Authors: Bluebond-Langner Myra , Langner Richard W. , Clemente Ignasi
Published: September 2021

Based on the holistic, family-centred approach of paediatric palliative care, this chapter examines specific aspects of the clinician, parent, and child roles in the care and treatment of children and young persons with life-limiting conditions and life-threatening illnesses. In particular, it identifies communication, information, decision-making, and participation preferences of children and young persons with advanced illness and their parents. Within the clinician–parent–child triad, the chapter sets forward suggestions for clinicians on how to manage differences between a child and his or her parents, and more generally, on how to approach the communication and decision-making processes throughout a child’s or young person’s illness trajectory.
Spiritual issues in palliative medicine
Authors: McClement Susan , Thompson Genevieve , Penner Jamie
Published: September 2021

The focus of palliative care is the whole person, including biopsychosocial, cultural, and spiritual dimensions of patient needs. The burgeoning literature examining the topic of spirituality within healthcare in general, and within palliative care in particular, underscores the notion that attending to patients’ spiritual care needs is a vital part of providing optimal palliative care. Yet healthcare providers frequently report that they feel ill equipped to provide spiritual care at the end of life and wrestle with many questions and uncertainties: What is spirituality? Why is it important? What is spiritual suffering? Who should provide spiritual care? How is a spiritual assessment conducted? What are some spiritual interventions for end of life care? What are some future research directions in the area of spiritual care? Answers to these questions form the basis of this chapter.
Integration of spiritual care into palliative care service delivery models
Authors: Beaussant Yvan , Nichipor Alexandra , Balboni Tracy A.
Published: September 2021

Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.
Practical bioethics in the care of patients with advanced illness
Authors: Macauley Robert C.
Published: September 2021

Perhaps no field of medicine faces more ethical dilemmas than palliative care, ranging from age-old questions (such as what constitutes ‘a good death’) to novel dilemmas stemming from technological innovation to a conflict of values in a multicultural context. Failure to identify and resolve these issues can fracture relationships and exacerbate suffering. Precisely because matters of morality are not quantifiable like other areas of medicine—and each person is a moral agent with their own beliefs and values—ethics may appear to be the one aspect of healthcare where everyone (regardless of training or role) possesses the tools to solve problems; in practice, however, it often seems that no one does. This chapter defines ethical dilemmas and equips clinicians with tools to recognize dilemmas that are ethical in nature, and those that only appear to be. Once identified as ethical, a structured approach consciously modelled on clinical assessment ensures that all relevant considerations are taken into account. Through effective communication and thoughtful use of additional resources (such as mediation, family meetings, and second opinions), the dilemma often can be resolved. When this does not occur, ethics consultation plays a valuable role both as prelude and complement to palliative care consultation. In situations where the best response remains unclear—or if clear, impossible to implement—clinicians may experience moral distress, which should be identified, navigated, and optimally prevented through conscious steps.
Palliative care needs assessment tools
Authors: Girgis Afaf , Waller Amy , Hobden Breanne
Published: September 2021

The delivery of appropriate and equitable care is a challenge facing many areas of healthcare, including palliative care. This chapter discusses the concept of needs assessment, which is inherent in the World Health Organization’s definition of palliative care, and considers strategies for assessment of needs and experiences. It focuses on tools developed specifically for this purpose, including generic needs assessment tools for any chronic disease and needs assessment tools for specific patient groups including those with advanced cancer, dementia, heart failure, chronic obstructive pulmonary disease, or HIV/AIDS. It reiterates the importance of needs assessment tools being implemented as part of routine care to facilitate the right care being offered to people at the time they most need it, by the people or service which is most appropriate to meet identified needs.
Apathy in Alzheimer’s Disease
Authors: Vieira Danielle , Liu Celina , Lanctôt Krista L.
Published: September 2021

Apathy is characterized by diminished goal-directed activity, loss of emotion, and reduced engagement in social interactions. It is a common neuropsychiatric symptom in Alzheimer’s disease (AD) and is present throughout every stage of the disease. This chapter comprehensively discusses the prevalence of apathy, its impact on patient and caregiver outcomes, the diagnostic criteria and validated scales used in the assessment of apathy, the neurobiology of this neuropsychiatric symptom, and findings from studies investigating the treatment of apathy in AD. Recommendations for future research include validating apathy scales to identify and measure apathy in AD, and consideration of neuroimaging techniques and biomarker analyses to better predict treatment response.
Neural Basis of Apathy
Authors: Agartz Ingrid , Mørch-Johnsen Lynn
Published: September 2021

This chapter introduces structural neuroimaging methods and presents results from brain imaging studies of the clinical apathy syndrome in neurodegenerative diseases such as Alzheimer’s disease, mild cognitive impairment, Parkinson’s disease, Huntington’s disease, and stroke, and also in schizophrenia, today considered a neurodevelopmental disease. The main method used has been magnetic resonance imaging, which also holds many innovative possibilities for future development. Scientific studies so far have pointed to structural differences in frontal, striatal, anterior cingulate, and parietal brain regions, and of white matter microstructure and connectivity changes as being involved in the apathy syndrome. No single circuit connected to apathy has so far been identified. Brain structure and function, studied at the systems network level, and integrative multimodal imaging approaches, which combine different high-resolution magnetic resonance imaging, magnetic resonance diffusion, and positron emission tomography techniques, can be helpful in resolving future questions.
Pharmacology of Apathy
Authors: Nobis Lisa , Husain Masud
Published: September 2021

While a high prevalence of apathy across neurological disorders is well established, there remains a paucity of evidence on effective therapies. As a result, there are currently no guidelines for the treatment of apathy. This chapter reviews the current state of research on different neurotransmitter systems implicated in motivation and apathy, as well as emerging pharmacological treatments across neurological conditions. Much research in animals has focused on the role of the mesocorticolimbic dopamine system in behavioural deficits of motivation. In turn, this has inspired several dopaminergic treatments for apathy in Parkinson’s disease, while drugs targeting catecholamines (dopamine and noradrenaline) or acetylcholine in conditions such as Alzheimer’s disease show some promise. However, poorly characterized dose-dependent effects, as well as interactions between different neurotransmitter systems complicate interpretation. Future research might profitably explore these factors to provide a better understanding of effective treatment approaches.
Brain Stimulation
Authors: Aleman André , Dlabac-De Lange Jozarni J. , Padala Prasad
Published: September 2021

Apathy is a disabling condition with a large burden of disease and lack of effective treatments. Over the past decades, new treatment modalities have been explored, including neuromodulation with repetitive transcranial magnetic stimulation (rTMS). An accepted treatment for depression in many countries, rTMS is well tolerated and has few side effects. The published evidence indicates that rTMS can reduce apathy/negative symptoms, although effects may be modest and transient. Less evidence is available for transcranial direct current stimulation, though it may also have potential to improve apathy. Thorough studies are needed to establish moderators of effect in order to optimize treatment parameters and thereby achieve more durable and clinically relevant effects.
Animatio
Authors: Obladen Michael
Published: September 2021

The onset of individual human life has fascinated thinkers of all cultures and epochs and the history of their ideas may shed light on an unsettled debate. Aristotle attributed three different souls to subsequent developmental stages. The last, rational soul, was associated with the formed fetus, and entailed fetal movements. With some modifications, the concept of delayed ensoulment—at 30, 42, 60, or 90 days after conception—was adopted by several Christian church fathers and remained valid throughout the Middle Ages. During the Enlightenment, philosophers began to replace the rational soul by the term personhood, basing the latter on self-awareness. Biological reality suggests that personhood accrues slowly, not at a specific date during gestation. Requirements for personhood are present in the embryo, but not in the pre-embryo before implantation: anatomic substrate; no more totipotent cells; and decreased rate of spontaneous loss. But biological facts alone cannot determine the embryo’s moral status. Societies must negotiate and decide on the extent of protection of unborn humans. In the 21st century, fertilization, implantation, extrauterine viability, and birth have become landmarks of change in ontological status.
Resuscitation 1
Authors: Obladen Michael
Published: September 2021

Mouth-to-mouth resuscitation of asphyctic newborns was used by midwives during the late Middle Ages and described by Bagellardo in 1472. The construction of manual ventilators by Hunter, Chaussier, and Gorcy seemed to set the stage for artificial ventilation of the neonate at the end of the 18th century. When Leroy d’Etiolles identified pneumothorax as a complication of ventilation in 1828, the Paris Academy of Science advised against positive pressure ventilation. Indirect techniques like that of Silvester or the Schultze swinging method gained widespread acceptance and prevailed until World War II. Modern ventilators were developed following the poliomyelitis epidemics in the 20th century.
Social birth
Authors: Obladen Michael
Published: September 2021

Rites of passage mark important changes during human life, and for the neonate, its transition from intrauterine life into society. Their original intent was to purify the body from blood and meconium, but the cleansing rites had a spiritual dimension from the very start. When the rites of Mesopotamian, Egyptian, Jewish, Greek, Roman, Hindu, Nordic, Muslim, Mayan, and Christian cultures are briefly compared, they reveal a remarkable similarity. What most rites had in common was the cleansing of the body, or sprinkling it with water; special clothing; the exorcism of evil spirits; blessings and prayers for good spirits; and a name-giving ceremony and a feast for family, relatives, and friends. Before this rite, the infant’s social existence was incomplete and it could easily be abandoned or killed, as was usual in case of severe malformations. Infant baptism originated in the 4th century c.e. with the concept of original sin. Rites of passage defined, but also set an end to, the liminal status between life and death, and granted the right to live for the infant.
Birthmark and blemish
Authors: Obladen Michael
Published: September 2021

The assumption that conceiving or pregnant women may harm their fetus by uncontrolled imagination originated in many cultures. Antique authors assumed visual impressions and fantasies of both parents at the time of conception or during coitus. In the late Middle Ages, only maternal, no longer paternal imagination was believed to harm the fetus, whose alleged vulnerability extended over the entire gestation. Whereas malformations were previously believed to result from untimely, adulterous, satanic, or bestial intercourse, the imagination doctrine now rendered the birth a misfortune rather than a crime, sparing maternal life and honour. In the 17th century, Fienus, Descartes, Helmont, and others developed sophisticated theories on its alleged mechanism. Systemic skin disease was related to visual impressions, local birthmarks to desires and touching her own body, and malformations were believed to result from terror with no role for the maternal hand. The imagination doctrine was discredited by the advent of teratology in the 18th century. However, it survived among the public and contributed to prejudging females as inferior, and to feelings of guilt and self-blame in mothers who gave birth to a malformed infant.
Pap, gruel, and panada
Authors: Obladen Michael
Published: September 2021

This chapter collects information on artificial infant feeding published before 1860, the date when commercial formula became available. There is extensive artefactual evidence from thousands of feeding vessels since the Bronze Age. Literature on the use of animal milk for infant feeding begins with Soranus in the 2nd century c.e. Literature evidence from the very first printed books in the 15th century proves that physicians, surgeons, midwives, and the laity were aware of the opportunities and risks of artificial infant feeding. Most 17th- to 19th-century books on infant care contained detailed recipes for one or several of the following infant foods: pap, a semi-solid food made of flour or breadcrumbs cooked in water with or without milk; gruel, a thin porridge resulting from boiling cereal in water or milk; and panada, a preparation of various cereals or bread cooked in broth. During the 18th century, the published opinion on artificial feeding evolved from health concern to moral ideology. This view ignored the social and economic pressures which forced many mothers to forego or shorten breastfeeding. Bottle feeding was common practice throughout history.
From swill milk to certified milk
Authors: Obladen Michael
Published: September 2021

Industrialization and urbanization jeopardized infant nutrition during the 19th century. Cow’s milk was produced in the cities or transported long distances under suspect conditions. Milk was contaminated with bacteria or adulterated with water, flour, chalk, and other substances. When distilleries proliferated in the metropoles, their waste slop was fed to cows who then produced thin and contaminated swill milk. Following a press campaign in the US, the sale of swill milk was prohibited in 1861. Bacterial counts became available in 1881 and helped to improve the quality of milk. Debates on pasteurization remained controversial. Disposal of the wastewater of millions of inhabitants and the manure of thousands of cows was environmentally hazardous. It was not until 1860 and after several pandemics of Asiatic cholera, that effective sewage systems were built in the metropoles. Milk depots were established in the US by Koplik for sterilized and by Coit for certified milk. In France, consultation services named goutte de lait distributed sterilized milk and educated mothers. Efforts to improve milk quality culminated in the International Congresses for the Prevention of Infantile Mortality.
Technical inventions that enabled artificial infant feeding
Authors: Obladen Michael
Published: September 2021

Artificial feeding of infants, called hand-feeding, was unsafe well into the 19th century. This chapter aims to identify technical innovations which made artificial feeding less dangerous. In rapid succession from 1844 to 1886, the vulcanization of rubber, production of rubber teats, cooling machines for large-scale ice production, techniques for milk pasteurization, evaporation and condensation, and packing in closed tins were invented or initiated. Remarkably, most of these inventions preceded the discovery of pathogenic bacteria. The producers of proprietary infant formula made immediate use of these innovations, whereas in the private household, artificial feeding remained highly dangerous—mostly because of ignorance about bacteria and hygiene, and partly because the equipment for safe storage, transport, preparation, and application of baby food was lacking.
Innocent blood
Authors: Obladen Michael
Published: September 2021

Haemorrhages occurring in the newborn without trauma have been observed by obstetricians since the 17th century, but were considered different diseases depending on their location. Umbilical haemorrhage associated with obstructed bile canals was described by Cheyne in 1802. Grandidier in 1871 and Townsend in 1894 grouped together various forms of neonatal bleeds and associated them with disturbed coagulation. When the clotting system became better understood in the last decade of the 19th century, effective symptomatic treatment was developed: gelatine, serum injection, and the transfusion of fresh blood. In 1935, Dam detected the function of vitamin K in the coagulation system and 4 years later, Waddell introduced vitamin K administration into therapy and prevention of neonatal haemorrhagic disease. When high doses of synthetic water-soluble vitamin K analogues were given to preterm infants, kernicterus occurred, reminding physicians that progress in neonatal therapy rests on the cornerstones of controlled trials and follow-up.
Filth, impurity, and threat
Authors: Obladen Michael
Published: September 2021

In many religions, body secretions have been regarded as impure or dangerous. Meconium, the pitch-like substance filling the gut at birth, was considered the embodiment of impurity and actively driven out from the newborn’s body. The custom was advantageous by breaking the taboo on colostrum consumption. Passing the meconium before birth was considered a bad omen. The claim that it indicated fetal death led to intense debates between the Parisian surgeons Viardel and Mauriceau. In 1798, Scheel described meconium aspiration into the airways, a severe disease still causing 1000 deaths annually in the US in 2008. Meconium ileus resulted from a hardened substance within the gut, linked to cystic fibrosis of the pancreas by Landsteiner in 1905. Meconium peritonitis, described by Morgagni in 1751, resulted when the dilated gut perforated during fetal life. A series of meconium occlusion and peritonitis were described in 1877 among infants admitted to the St. Petersburg Foundling Hospital. For centuries, ‘expelling’ the meconium was a postnatal routine with similarities to exorcism, freeing the child from evil.
From right to sin
Authors: Obladen Michael
Published: September 2021

This chapter investigates changes in infanticide legislation as indicators of the attitude of states towards the neonate. In antique East Asian societies in which the bride’s family had to pay an excessive dowry, selective female infanticide was the rule, despite formal interdiction by the law. In Greece and Rome, children’s lives had little value, and the father’s rights included killing his own children. The proportion of men greatly exceeding women found in many cultures and epochs, suggests that girls suffered infanticide more often than boys. A kind of social birth, the ritual right to survive, rested on the procedure of name giving in Roman culture and on the start of oral feeding in Germanic tradition. Legislative efforts to protect the newborn began with Trajan’s ‘alimentaria’ laws in 103 c.e. and Constantine’s laws following his conversion to Christianity in 313 c.e. Malformed newborns were not regarded as human infants and usually were killed immediately after birth. Infanticide was formally outlawed in 374 c.e. by Emperor Valentinian.
General principles and techniques
Authors: Kay Simon , McCombe David
Published: September 2021

Plastic surgery pursues the amelioration of acquired or congenital defects, to restore both function and form. Uniquely among surgical specialties, plastic surgery is defined by concept rather than by tissue or anatomical region. The concepts and techniques that are its foundation may be applied throughout the body irrespective of tissue type, to reconstruct or repair deficiencies resulting from trauma, disease, or birth defects. To the uninformed, it appears a solely technical specialty, but in truth, the interactions between form, function, and human behaviour are so intimate that diagnosis and treatment must consider each of these aspects. In particular, it requires a detailed understanding of human behaviour and its variants in a wide variety of circumstances to treat the individual effectively.
Non-melanoma skin cancer and premalignant conditions
Authors: Jemec Barbara , Jemec Gregor B.E.
Published: September 2021

This chapter describes the diagnosis, non-surgical treatment, and surgical treatment of non-melanoma skin cancers, such as basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and others.
Pigmented lesions and melanoma including premalignant conditions
Authors: Henderson Michael , Spillane John , Gyorki David , McCormack Christopher
Published: September 2021

Throughout the world, each year, approximately 250,000 people develop melanoma and 40,000 die from the disease. Melanoma is characteristically a disease of fair-skinned persons exposed to high ambient levels of ultraviolet (UV) radiation. The incidence has doubled over the last 20 years although unlike other countries the rate of increase in Australia has slowed in recent years, possibly due to public education campaigns targeting excessive UV exposure. Globally the incidence in patients over the age of 65 continues to increase and accounts for disproportionately more melanoma-related deaths. Nevertheless, melanoma in younger persons (<35 years) is among the leading causes of cancer-related mortality in fair-skinned populations. Until the last decade, the outlook for patients with advanced melanoma was uniformly poor but the development of specific therapies targeting the mitogen-activated protein kinase pathway (mutated BRAF melanoma) and immune checkpoint therapy has delivered enormous improvements in outcome.
Wound dressings
Authors: Stewart David
Published: September 2021

The plastic surgeon is often called upon to manage the complex or chronic wound. While an understanding of the principles of surgical debridement and reconstruction is naturally required for plastic surgical practice, it behoves the surgeon to also have a thorough understanding of the non-surgical aspects of wound management. The choice of dressings should be based on an understanding of what one is trying to achieve. Dressings can be indicated to aid in closure, prevent contamination, maintain hydration, debride, temporize while waiting for surgery, treat infection, and reduce swelling and inflammation. Often the choice will be based on individual preference and local availability, but understanding the varied properties of available dressings will allow the plastic surgeon to have an algorithmic approach to wound dressing.
The Schwann cell
Authors: Kingham Paul J. , Wiberg Mikael
Published: September 2021

Theodor Schwann, a German physiologist and one of the founding fathers of cellular theory, was the first to hypothesize the association between myelin (the insulating fatty substance surrounding peripheral nerve axons) and the cells that later took his name. In addition to their central role in facilitating the conduction of fast axon potentials, there exist a number of Schwann cell subtypes that are responsible for maintaining normal neural function and signalling at the neuromuscular junction. This chapter provides an overview of the development of the Schwann cells from their neural crest origin and the molecular changes associated with formation of the diverging myelinating and non-myelinating phenotypes. The role of Schwann cells in assisting peripheral nerve axon regeneration is also discussed.
Clinicopathological correlates with theoretical grades
Authors: Bains Robert , Kay Simon
Published: September 2021

Nerve injury may present with temporary and short-lived loss of function progressing to full recovery or with complete loss of function, severe pain, and no prospect of spontaneous improvement. Many cases lie between these two extremes and the classification systems described in this chapter will aid identification and understanding of an individual injury with the intention to predict outcome and so guide management.
Neurophysiological assessments for peripheral nerve injury
Authors: Mallik Arup
Published: September 2021

Neurophysiology is a useful investigation to assess peripheral nerve injury. It consists of nerve conduction studies and electromyography, providing information on anatomical distribution of the lesion (pre/postganglionic, single/multiple nerves), whether the lesion is primarily demyelinating or axonal, and whether the lesion is in continuity, as well as the overall prognosis.
Surgical management of the divided nerve
Authors: McGrouther Duncan A.
Published: September 2021

This chapter describes the principles of peripheral nerve repair by direct repair or nerve graft with specific discussion of assessment, exposure, and techniques of nerve repair. Notes on specific nerve injuries, neuroma management and outcomes are included.
Pathophysiology
Authors: Hart Andrew
Published: September 2021

Compression neuropathy is the commonest form of peripheral nerve injury and refers to the symptoms and clinicopathological findings that arise when a peripheral nerve is subjected to acute or chronic external compression or impingement of sufficient magnitude to impair its microcirculation. As aerobic glycolysis fails, membrane potential regulation is impaired, and action potential transmission fails. The differential susceptibility of the various fibre types, which subserve different functions, results in a typical progression of symptoms from impaired fine touch and proprioception, through paraesthesia, to poorly localized pain. If compression persists, then secondary intraneural and vascular anatomical changes establish a downward spiral of worsening intraneural oedema and fibrosis, axonotmesis, and denervation atrophy of target muscles. The condition becomes refractory to decompression. The impact on the patient depends upon the severity of neuropathy, and the nerve affected. A small number of anatomical sites particularly predispose to compression (e.g. the carpal tunnel), resulting in the common clinical syndromes.
Blood supply of the peripheral nerve
Authors: Hart Andrew
Published: September 2021

The anatomy of the blood supply of the peripheral nerve is described in this chapter together with the circumstances and implications where the nerve vascularity is compromised.
Orthopaedic management of congenital pseudarthrosis of the tibia
Authors: Monsell Fergal
Published: September 2021

Congenital pseudoarthrosis of the tibia is an uncommon but important condition, often associated with neurofibromatosis, in which the tibia has a region of abnormal bone prone to fracture and subsequent non-union with a fibrocartilaginous pseudoarthrosis forming at the fracture site. The limb is prone to malalignment and distal deformity. Management requires correction and stabilization of the deformity with excision of the affected tissue of the tibia and reconstruction either with bone grafting, transport, or transfer of vascularized fibula.
The skeletal consequences of meningococcal septicaemia
Authors: Monsell Fergal
Published: September 2021

Meningococcal septicaemia and its complication of purpura fulminans has a significant impact upon the extremities as the ischaemic insult caused by the intravascular thrombosis typical of the fulminant infection can lead to gangrene and tissue loss in the acute phase of illness and the late sequelae of growth arrest and deformity. The initial management and long-term assessment and intervention are described in this chapter.
Hair restoration
Authors: Darhouse Nagham , Williams Greg
Published: September 2021

Hair restoration focuses on replacing hair where it has been lost, although there is also a demand for hair to be placed where it is desired, but lacking, for a perceived aesthetic gain. For both men and women, hair loss can be devastating and lead to loss of confidence and self-esteem. Hair restoration can be beneficial but treatment should be tailored to the individual’s needs and the correct diagnosis for the hair loss needs to be determined through a detailed history, thorough examination, and appropriate investigations. The average human has over 5 million hair follicles of which only about 100,000 are located on the scalp. While it is loss of scalp hair that is often most noticeable and distressing, eyebrow and eyelash hair loss is also very obvious in both sexes, as is loss of beard and moustache hair in men. Hair loss may be localized or generalized, part of a medical condition, a side effect of medications, the result of a dermatological condition, or genetically predetermined. Hair restoration can be achieved through medical treatment, surgery, and non-surgical alternatives.
Assessment of the maxillofacial patient
Authors: Mannion Christopher J.
Published: September 2021

The assessment of the facial trauma patient requires a systematic approach with initial emphasis given to the principles of the Advanced Trauma Life Support® programme. Specific assessment of injury to the maxillofacial skeleton and associated ocular injuries are also described in this chapter.
Zygomatic complex fractures
Authors: Brown A. Nicholas
Published: September 2021

The zygoma is commonly fractured in facial trauma. The zygoma forms the anterolateral prominence of the face as well as contributing to the orbit and maxillary buttress. The assessment and management of zygomatic fractures are described in this chapter.
Fractured nasal bones
Authors: Brown A. Nicholas
Published: September 2021

Nasal fractures are a common sequelae of facial trauma. The anatomy of the nose is important to appreciate in allowing accurate assessment and appropriate treatment. The classification and management of nasal fractures are described in this chapter.
Management of midface fractures: maxilla
Authors: Parmar Jiten D. , Carter Lachlan M.
Published: September 2021

Maxillary fractures can be classified according to fracture pattern as described by the Le Fort classification. These are usually high-energy injuries and there are often other facial injuries associated with these fractures that need to be identified and managed in addition to the treatment of the fracture itself. Fracture treatment is by reduction and stabilization, usually with internal fixation. Complications of the injury and treatment are discussed in this chapter
Frontal sinus and nasoethmoidal injuries
Authors: Ahmed Nabeela , Carter Lachlan M. , Singh Rabindra P.
Published: September 2021

The frontal sinus and the adjacent naso-orbitoethmoid complex of bones in the midline are vulnerable to direct trauma and significant injuries can involve the adjacent skull base, the nasofrontal duct, and the medial orbit. The anatomy of this critical area is complex. Assessment of the injury includes ocular and neurological examination for associated injuries, and high-resolution computed tomography scanning is required for accurate definition of the injury. In this chapter, the principles of management and the complications of these fractures and their management are described.
Sequencing of panfacial fracture repair
Authors: Parmar Jiten D. , Carter Lachlan M.
Published: September 2021

Panfacial fractures involve multiple fractures of the upper, middle, and lower thirds of the face. In management of panfacial fractures, the individual fracture techniques and approaches described in the previous chapters in Section 7 are combined to restore bony continuity of the facial skeleton and provide an aesthetic and functional drape of the overlying soft tissues. The aim in treatment of panfacial fractures is to restore the anatomical buttresses of the face in three dimensions, thus restoring vertical face height, horizontal width, and anteroposterior projection.
Common orthognathic procedures
Authors: Bates Claire , Mannion Christopher J. , Carter Lachlan M.
Published: September 2021

The mainstays of orthognathic surgery are Le Fort I osteotomy of the maxilla, sagittal split osteotomy of the mandible, and genioplasty of the mandible. These procedures are described in this chapter together with the complications associated with them. The principles of distraction osteogenesis of the mandible and the indications for this procedure are also described.
Embryology and development of the chest wall and breast
Authors: Lam Quoc
Published: September 2021

The concepts of embryogenesis of the chest and breasts intimately influence a surgeon’s approach to reconstruction of this region. Development of the chest and breasts begins in utero, but dramatic changes occur after birth during puberty, pregnancy, and menopause with intervals of relatively little change in between. The breasts have a complex multifaceted role in the physical and psychosocial development of a female. Plastic surgical approaches to congenital and acquired defects of the chest and breast are sensitive to these developmental phases in order to balance form, function, and psychosocial well-being. The many congenital disorders of the breast and chest exemplify errors at various stages of development.
Breast malignancy
Authors: Horgan Kieran , Dall Barbara , Millican-Slater Rebecca , Bramhall Russell , MacNeill Fiona , Dodwell David , Chaudhuri Indu , Trainor Sebastian
Published: September 2021

Breast cancer is the commonest cancer to affect women in developed countries and is increasing in frequency in the Western world. Approximately 50,000 women and 400 men are diagnosed with breast cancer in the United Kingdom each year. Eighty per cent of these individuals will survive for at least 5 years after diagnosis. In 2012, 11,762 women died of breast cancer in the United Kingdom. Age-standardized rates of new invasive breast cancer diagnosis have increased from 75 to 126 per 100,000 population in the United Kingdom between 1977 and 2010.
Breast reconstruction
Authors: Dean Nicola R.
Published: September 2021

In post-mastectomy breast reconstruction, appropriate assessment of the patient’s requirements and evaluation of their suitability for any particular procedure is essential to ensuring a good outcome. The clinic environment, history taking, and examination are covered in this chapter. How to explain different types of procedures to patients and how to present them with evidence around different methods of breast reconstruction is a major focus of this chapter. Risk assessment and important elements of consent form the final part of the chapter.
TRAM flap breast reconstruction
Authors: Januszkiewicz Janek S.
Published: September 2021

The transverse rectus abdominis myocutaneous (TRAM) flap retains a prominent role in contemporary breast reconstruction surgery. This chapter reviews the origins and anatomy of the TRAM flap, both as a pedicled and free tissue transfer. Patient selection and flap planning are examined in the context of immediate and secondary breast reconstruction with attention to oncological considerations and patient risk factors. The elements influencing choice between a pedicled or free flap are discussed and some guidelines to decision-making for abdominal based breast reconstruction are offered. Detailed descriptions of surgical technique and perioperative care follow, illustrated by case examples.
DIEP flap breast reconstruction
Authors: Ashton Mark
Published: September 2021

This chapter presents an overview of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction. The vascular basis of the DIEP flap and surgical technique are described in detail. Planning, preoperative investigations, and how to select the ideal perforator are discussed. Tips to avoid complications are also presented.
Ancillary considerations in breast surgery
Authors: Clark Emily G. , Mueller Melissa A. , Evans Gregory R.D.
Published: September 2021

Debated topics and new and evolving techniques in breast surgery are discussed in this chapter. Antibiotics and the use of closed-suction drains vary among surgeons, but the existing evidence favours discontinuation of antibiotics within 24 hours in most cases, and the indications for drains are limited but include breast reconstruction with acellular dermal matrix (ADM). ADM is a biological tissue substitute with many applications in breast surgery. The product selected and surgical technique used are often case specific; cost and patient anatomy play major roles. Although not suitable for all patients, ADM is an asset to prosthetic breast reconstruction. In addition, ADM is useful in the correction of breast surgery complications, including malpositioning and capsular contracture. It may be combined with fat grafting to mask rippling. Fat grafting, or lipomodelling, is an evolving science with promising results. Technique is critical for good results, and is described in this chapter. Radiographic changes after fat grafting are usually discernible from suspicious lesions, and growing evidence supports the oncological safety of this procedure
Mechanisms of burn injury
Authors: Sood Ravi F. , Gibran Nicole S.
Published: September 2021

Burns comprise a highly heterogeneous group of injuries resulting from a variety of mechanisms. In order to provide adequate care for the burned patient, providers must be familiar with mechanism-specific factors. This chapter reviews common types of burn injuries requiring burn-centre admission, including those resulting from heat, cold, electricity, chemicals, and radiation. Specifically, the chapter focuses on clinically relevant differences in epidemiology, injury patterns, and pathophysiology. These considerations directly inform management and prevention of burn injuries and provide an essential framework for modern burn care.
Functional anatomy of the abdominal wall
Authors: Echlin Kezia
Published: September 2021

This chapter describes the functional anatomy of the abdominal wall. The layers of the abdominal wall consist of skin, superficial fascia, deep investing fascia, muscles, and inner fascial layers: transversalis fascia, extraperitoneal fascia, and peritoneum. The layers are variable in different areas of the abdomen. Skeletal support for the abdomen is derived from the lumbar vertebrae, the superior parts of the pelvic bones, and the bony parts of the inferior thoracic skeleton: the lower ribs and their costal cartilages and the xiphoid process.
The principles of complex abdominal hernia repair
Authors: Echlin Kezia , Fleming Andrew
Published: September 2021

Large, complex abdominal hernias can be repaired with the component separation technique, which creates sliding bipedicled flaps of the rectus abdominis to allow autogenous repair of midline, ventral hernias. This technique involves longitudinal release of the external oblique aponeurosis just lateral to the linea semilunaris, and developing the plane between the external and internal oblique muscles to allow the rectus abdominis muscle and sheath to slide medially. Modifications of the original technique include the addition of mesh reinforcement, release of the deeper elements of the abdominal wall, and sparing of the peri-umbilical perforators to the skin from the deep inferior epigastric artery. Component separation technique is an effective technique to repair large ventral hernias but carries a significant risk of wound complications and a risk of cardiorespiratory compromise.
Functional anatomy of the pelvis and gluteal region
Authors: Hudson Donald , Moodley Sean
Published: September 2021

A thorough understanding and knowledge of the regional anatomy of the pelvis and gluteal regions is essential for the understanding of the pathology and the flaps required for the reconstruction of various defects. The bony and ligamentous structure of the pelvis and the muscular and vascular anatomy of the gluteal region are described.
Perineal reconstruction following anorectal excision
Authors: Crick Alexandra
Published: September 2021

Anorectal abdominoperineal excision, either as a primary procedure for rectal cancer or as a salvage procedure for residual or recurrent anal cancer following chemoradiotherapy, creates a defect of the pelvic floor, pelvic dead space, and a perineal skin defect and may include a defect of the posterior vaginal wall. The ideal reconstruction should address all components of this defect and aims to achieve primary uncomplicated healing while preserving and restoring function. Pedicled flaps from the abdomen, gluteal and thigh regions, and occasionally free flaps are available for this purpose. There is increasing evidence that flap reconstruction improves perineal healing especially where there is a history of radiotherapy.