bluuebunny/crossref_metadata_2025_split huggingface dataset:
404 Efficacy and Long-Term Outcomes of Skin Grafts Versus Dorsal Flaps in Syndactyly
Authors: Baltag D 
Published: October 2021

Abstract

Aim
Syndactyly is a congenital condition which is commonly resolved around 18-24 months of age using either a full-thickness skin graft or a flap to address the skin shortage in the web-space. The aim is to review and compare the long-term outcomes of these techniques.

Method
Using medical databases, 673 citations were identified between the years 1966 and 2016 related to simple syndactyly. Of these, 34 were chosen: English-language articles, simple isolated syndactyly, i.e., not syndromic, and procedures using a dorsal-metacarpal advancement flap or skin graft. Outcomes were divided into early post-operative and long-term; earlier outcomes being graft failure and flap necrosis, and long-term outcomes being web creep, scar hypertrophy or contracture, and revision surgery. ORs were calculated to compare rates of complication between the two procedures.

Results
Early post-operative complications showed a statistically significant difference in incidence; both individual and combined incidence (OR, 9.4; 95% CI, 3.6-24.8; P &lt;.05) were more likely to occur in the graft group. Incidence of web creep, (OR, 12.9; 95% CI, 1.7-96.6; P&lt;.05), contracture (OR, 4.5; 95% CI, 1.4-13.6; P &lt; .05) and scar hypertrophy (OR, 49.3; 95% CI, 1.3-215.0; P &lt; .05) were also statistically significant in comparison of the two techniques and more likely to occur in the graft group.

Conclusions
While there is data to suggest a superiority in flap procedures, there is a lack of standardization across studies which undermines the power of systematic reviews and hence a uniform classification would improve the quality of existing research.
424 Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training for Theatre Nurses
Authors: Gowda S , Mohan A 
Published: October 2021

Abstract

Aim
Shared mental models between surgeons and scrub nurses allow them to effectively communicate with each other and react efficiently to intraoperative complications. Microsurgery poses unique challenges including the use of an operating microscope, fine instruments, and restricted views of the operative field. Our aim was to design and deliver a microsurgical skills session for theatre nurses and evaluate whether attendance influenced perceived understanding of microsurgery and ability in day-to-day role.

Method
A microsurgical training day for theatre nurses was delivered. This consisted of an introduction to and positioning of the operating microscope and three practical stations involving increasingly complex motor tasks, designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub nurses to add an element of role-reversal. Qualitative and quantitative feedback was collected.

Results
Eight theatre nurses participated, all responded ‘strongly agree’ or ‘agree’ that the training was enjoyable, improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees strongly agreed that they would partake in similar sessions in the future.

Conclusions
Role-reversal and skills-based training is a valuable tool in improving multidisciplinary collaboration in microsurgery. Increasing shared knowledge of complex procedures prospers effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step towards development of a standardized microsurgical skills course for theatre nurses and has broader implications for interprofessional education across all surgical specialties.
507 Quantifying the Limitations of Clinical and Technology-Based Flap Monitoring Strategies Using A Systematic Recurrent Themes Analysis
Authors: Kwasnicki R , Noakes A , Banhidy N , Hettiaratchy S 
Published: October 2021

Abstract

Aim
Multiple techniques exist to monitor free flap viability postoperatively, varying with practical and personal preference, yet the limitations of each technique remain unquantified. This systematic review aims to identify the most commonly reported limitations of these techniques in clinical practice.

Method
A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE and Web of Science with search criteria for postoperative free flap monitoring techniques. Search results were independently screened using defined criteria by two authors and a senior clinician. Limitations of the techniques found in the discussion section of eligible papers were recorded and categorised using recurrent theme analysis.

Results
A total of 4826 records were identified. 4643 articles met the eligibility criteria and were subsequently reviewed, with 195 papers included in the final analysis. The most frequently reported limitations of clinical monitoring were interpretation requiring expertise (25% of related papers), unsuitability for buried flaps (21%), and lack of quantitative/objective values (19%). For non-invasive technologies: lack of quantitative/objective values (21%), cost (16%) and interpretation requiring expertise (13%). For invasive technologies: application requiring expertise (25%), equipment design and malfunction (13%) and cost (13%).

Conclusions
This is the first systematic review to quantify the limitations of different flap monitoring techniques as reported in the literature. The limitations identified better inform clinicians to decide the best single or combined monitoring approach for their practice and aid development in new flap monitoring technologies.
529 Safeguarding Skin Grafts: A 21st Century Algorithm for Fixation Techniques
Authors: Patel B , Asher C , Bystrzonowski N , Healy C 
Published: October 2021

Abstract

Aim
Effective skin graft fixation is fundamental in preventing sheering forces, seroma and haematoma from compromising graft take. However, determining the ideal method of graft fixation remains a contentious subject. Currently, there is significant variation in fixation techniques used, based not only on clinical requirement, but also surgeon preference. Evidence-based recommendations are necessary to guide the decision-making process.

Method
We undertook a PRISMA-based assessment of the literature to define all fixation techniques and analyse their outcomes. Inclusion and exclusion criteria were composed. A search of Medline and Embase was performed, yielding 399 articles. After abstract screening, 96 were included for qualitative data analysis.

Results
Nine fixation techniques were identified: ‘tie over bolster’, ‘staple fixation’, ‘simple dressings’, ‘quilting sutures’, ‘re-look methods’, ‘foam sponge bolster’, ‘adhesive glues’, ‘negative pressure wound therapy’ and ‘less common techniques. We analyse the available evidence for each technique, identifying 13 studies with level I/II evidence. We summarise the research that underpins these nine categories, proposing an algorithm to facilitate technique selection based on anatomical and patient-specific factors.

Conclusions
An array of skin graft fixation techniques are used in plastic surgery, without clear guidelines. To our knowledge, this is the first time all fixation techniques have been defined. Our suggested algorithm is intended to aid surgeons in selecting an appropriate fixation technique and should be challenged by future research, particularly randomised control trials.
599 Intramammary Melanoma Micrometastasis Within A Silicone Implanted Breast
Authors: Payne A , Welman T , Stodell M 
Published: October 2021

Abstract

Case Summary
Melanoma of the abdominal wall is not uncommon, and sentinel lymph nodes are usually located in the lymphatic drainage basins of the axilla or inguinal region. Less frequently, interval sentinel lymph nodes can be found along the lymphatic vessels between the primary cancer and nearest basin.
We present the case of a 53-year-old female with silicone breast implants who underwent scar excision and sentinel lymph node biopsy for a 1mm Breslow thickness superficial spreading melanoma of the abdomen. Two lymph nodes were excised; both lying in the subcutaneous fat at the lateral aspect of the right breast capsule. Lymph node histology revealed a subcapsular melanoma deposit along with silicone lymphadenopathy in the sentinel node, and silicone lymphadenopathy in the second node. Whole body positron emission tomography (PET/CT) and magnetic resonance imaging (MRI) of the brain showed no evidence of metastases or implant rupture. Subsequent MRI breast revealed likely intracapsular implant rupture. The patient was offered removal of implants and remains under follow-up.
The unusual location of the sentinel node in our patient highlights the possibility that previous breast augmentation may have altered the pattern of lymphatic drainage to the axilla. In addition, to our knowledge, this is the first reported case of silicone and melanoma deposits in a single sentinel node.
640 Improving Junior Doctors’ Knowledge and Confidence in Assessment, Management and Referral of Burns Patients in the Emergency Department, Royal Oldham Hospital
Authors: Connolly M , Gangahar R 
Published: October 2021

Abstract

Aim
There are currently no online trust guidelines for adult burn injuries. We aim to improve ED trainee knowledge and confidence in managing burns patients by delivering focused teaching and developing accessible online resources.

Method
A survey circulated to junior doctors assessed their confidence in managing minor and major burns injuries. Focused teaching on burns depth, management of burns wounds and when to refer was delivered to ED trainees after completion of the survey. Online tools and resources for assessment, management and referral of burns were developed using NICE and British Burns Association Guidelines. Resources were circulated to trainees and a survey repeated to assess confidence.

Results
Initial surveys demonstrated 71% felt confident in assessing minor burns and 46% for major burns. When managing minor burns 68% of juniors felt confident and 43% for major burns. Only 25% were aware of referral criteria to a burns centre for major burns and 32% for minor burns. Following focused teaching sessions, clinician confidence in assessment and management of all burns improved to 100%. Awareness of referral criteria rose to 85-92% for all burn injuries. Qualitative feedback was positive amongst different levels of health care professionals for the new resources.

Conclusions
Burns injuries are common, yet confidence is low amongst junior doctors in their management. This was compounded by a lack of local guidance. Focused teaching and implementation of accessible online departmental guidance has improved clinician confidence and helped ensure that patients presenting with burns are managed by confident clinicians according to national guidelines.
713 Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Procedures During COVID-19: A Single Centre Experience
Authors: Sutcliffe A , Khera B , Khashaba H 
Published: October 2021

Abstract

Aim
WALANT procedures are becoming more popular and are particularly useful in the COVID-19 pandemic. Procedures can be performed without needing access to general theatres and anaesthetic support, minimising the number of patient-healthcare interactions and avoiding aerosolisation.
Our unit has taken this approach and aim to present a case series that demonstrates the efficacy and safety of WALANT.

Method
A retrospective analysis of WALANT cases in a single plastic surgery centre during March-August 2020 was performed. All procedures using a WALANT approach were included, that would have otherwise required general anaesthetic or regional block. Data was collected on a number of variables, including patient satisfaction.

Results
37 procedures were included in analysis. The majority of the injuries consisted of hand trauma. There were no cases of post-operative complications, although one required completion in main theatres due to technicality. No patients required additional anaesthetic during the procedure and all reported pain score as 0/10. Overall patient satisfaction was 10/10 for 26 patients, 9/10 for 10 patients and 7/10 for one patient.

Conclusions
Results show the use of WALANT can facilitate an effective plastic surgery trauma service during COVID-19. Most of the procedures were performed in the outpatient department setting, without the need for main operating theatres or anaesthetic support. All procedures were performed within 24 hours of initial presentation and were able to be discharged on the same day. In addition, patient satisfaction remained high and post-operative complications were minimal. We propose that the use of WALANT should continue and increase beyond the current pandemic.
931 Deep Inferior Epigastric Perforator (DIEP) Flap: Impact of Early Drain Removal on Seroma Formation Rate and Duration of Inpatient Stay
Authors: Grigg K , Clancy R , Lewis C , Jackson P 
Published: October 2021

Abstract

Aim
Donor site seroma can follow deep inferior epigastric flap (DIEP) harvest. Post-surgery gradient technology (GTC) garments are worn by DIEP patients postoperatively following drain removal to reduce seroma formation. Early drain removal was considered a contributing factor to increased seroma formation rate. From June 2018 drain removal regardless of output was instigated at day two post-surgery. Prior to this, drains were removed when less than 30mls over 24 hours. We aim to assess the seroma rate post DIEP harvest with early drain removal.

Method
Retrospective review of prospectively managed database between June 2018 to May 2020. Surgical complications and length of stay in hospital were recorded.

Results
200 patients underwent DIEP flap breast reconstruction. The mean age of patients was 52 years (range 28-73). There was no significant difference in seroma complication rate between those who had drains removed on day 3 compared with day 2 ((1.02% (1/98) vs. (0.98% (1/102); p = 1). The mean length of stay in hospital for the 1st cohort was 3.86 days and for the 2nd cohort was 3.23 days. There were no complications related to drain removal.

Conclusions
Our data suggests that drain removal after 2 days postoperatively with DIEP reconstruction does not affect seroma complication rates. Moreover, it leads to a shorter hospital stay. These conclusions are in keeping with enhanced recovery protocols and an early drain removal surgical process could be advised.
942 Outcome of Image Guided Intra-Articular Thumb Base Steroid Injections-Retrospective Study of Consecutive Patient Over 4 Years in A Plastic and Hand Surgery Unit in West Lothian, Scotland
Authors: Thazhathe Peedika N N , Goswami P 
Published: October 2021

Abstract

Introduction
Osteoarthritis of the thumb base is a common condition. Usually effects the elderly population causing significant disability. Modalities of treatment of osteoarthritis which includes conservative measures, non-operative interventions, and surgery.
In this study we endeavored to assess how effective are image guided steroid injections for base of thumb Osteoarthritis as assessed by subjective pain relief perceived by patient and what percentage of these patients proceed to operative treatment.

Method
Retrospective data between January 2015 and December 2018 of the patients who underwent Steroid injections to the Base of thumb joints (CMCJ and/or STTJ) for Osteoarthritis under image intensifier guidance was collected from Hospital management system –TRAK and eHealth services. Follow up of the patients were done for Maximum 1 to 5 years.

Results
A total number of 692 patients with thumb base osteoarthritis were included in the study of which 546 patients underwent Image guided steroid injection to the thumb base. The mean Age of patients was 64.5 years and the Female: Male ratio was 401:145. Mean number of injections each patient received- 3.25 (1 – 7 times). Pain relief after first, second and third injections were 3.15 months, 2.63 and 1.75 months, respectively. 127 (23.2% of injections patients) underwent trapeziectomy. Mean time between first injection & Surgery was 1.3yrs (6 months -2 years)

Conclusions
This study demonstrates the effectiveness of image guided steroid injections for thumb base osteoarthritis. Though about a quarter of these patients proceed to operative management, steroid injections can delay the same considerably.
1024 The Use of the Pedicled Anterolateral Thigh (ALT) Flap for the Reconstruction of Abdominal Wall Defects in High-Risk Patients: A Case Series and Systematic Review
Authors: Newall N , Jones C , Ho W , Curnier A 
Published: October 2021

Abstract

Introduction
The pedicled anterolateral thigh (ALT) flap is considered as a suitable option in complex abdominal wall reconstruction. Its use as a reconstructive option is infrequent in the literature, and to date, there has been no systematic review evaluating its long-term outcomes. We report our experience with the pedicled anterolateral thigh flap for abdominal wall reconstruction in high-risk patients.

Method
A prospective database was created for patients with abdominal wall defects treated with pedicled ALT with extended fascia lata flaps between 2014 and 2017. Patient demographics, aetiology, size, location of defect and post-operative results were reviewed. Abdominal defects were classified into the following zones: 1A, upper midline; 1B, lower midline; 2, upper quadrant; 3, lower quadrant. A systematic review of the literature was conducted using PUBMED and EMBASE.

Results
4 patients (mean age 59.5 years, range 50-65 years) underwent reconstruction with pedicled ALT flaps. 3 flaps developed partial necrosis secondary to infection; 1 flap required surgical debridement, and 2 were managed conservatively. There was one flap failure, due to avulsion of the pedicle during inset. At mean follow up of 2.75 years (range 1 to 4 years) 3 patients have clinical bulging or herniation.

Conclusions
Review of the literature demonstrated 52 patients from 17 case series or reports. The overall infection and partial flap loss rates were both 6%. There were no reported flap failures. Our study demonstrates that the pedicled anterolateral thigh flap is an effective flap option for the repair of large defects of the abdominal wall in high-risk patients.
1051 The Effect of Ginger Oil on Postoperative Nausea and Vomiting (PONV) After Breast Augmentation Surgery
Authors: Saghir N , Saghir R , Sidhu M , Okhiria T , Okhiria R , Husein R , Sforza M 
Published: October 2021

Abstract

Aim
Postoperative nausea and vomiting (PONV) is one of the commonest complaints following general anaesthetic. Poorly controlled due to its multifactorial nature most current antiemetics are not effective and have an undesirable side effect profile. As such we have studied the effect of Ginger (Zingiber Officinale), a relatively inert yet powerful antiemetic and its properties in managing PONV.

Method
A double-blind (surgeon/anaesthetist), randomised, placebo-controlled, single-centre study was carried out in a homogenous 30 female patient cohort undergoing breast augmentation surgery. Participants were randomly allocated to have 3 drops of either Ginger oil (110mg Zingiber officinale) or a simple control oil on the laryngeal mask before insertion. PONV and visual analogue scales (VAS) were used as outcome measures and were plotted against the dose of morphine used in the patient.

Results
Multivariate analysis of variance (MANOVA) was conducted on the data. Using Pillai’s trace, there was a significant effect of ginger on PONV/VAS, V = 0.87, F(3,16)=34.78, P &lt; 0.001. Separate univariate ANOVAs showed: PONV Mean=1.70, PONVSD=0.48 compared with no ginger treatment plan group; PONV Mean=4.20, PONVSD=0.79. VAS Mean= 5.0, VASSD=1.63 for the ginger treatment plan group; and VAS Mean=5.9, VASSD=2.33 for the no ginger treatment plan group.

Conclusions
This study has found that ginger has an important role in preventing postoperative vomiting, reducing postoperative nausea, and is useful in breast augmentation. We have demonstrated a novel application of ginger oil during induction of anaesthesia and have provided evidence of its use in opioid-induced PONV.
1058 DVT And Abdominoplasty: A Holistic 8-Point Protocol-Based Approach to Prevent DVT
Authors: Saghir R , Saghir N , Okhiria T , Sidhu M , Okhiria R , Husein R , Sforza M 
Published: October 2021

Abstract

Aim
Plastic surgery as a speciality is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT).

Method
A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7- year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours.

Results
Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Due to the zero-incidence rate of DVT, different hypotheses of DVT proportions were tested to find out the rates that could be statistically consistent with our sample, thereby providing conservative incidence rate estimates.

Conclusions
This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We therefore believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery
1076 Online Availability of Hand Splints for Patients with Common Upper Limb Nerve Entrapment Syndromes During COVID-19 Pandemic
Authors: Teoh S H , Jivan S 
Published: October 2021

Abstract

Aim
Splinting is first line treatment in mild to moderate cases of carpal and cubital tunnel syndrome. During COVID-19 lockdown, patients experience prolonged waiting time for their splints from specialist service if not requiring surgery. Many of our patients have not trialled splinting prior to their specialist appointments. We aimed to look at the quality of splints commercially available for the general public to purchase thereby starting treatment earlier.

Method
Hand splints for nerve entrapment are readily available through two of the biggest UK online retailers, Amazon.co.uk and eBay.co.uk. We searched the terms ‘carpal’ and ‘cubital’ tunnel splints on both sites, the top 5 results were assessed for their suitability, accessibility, and affordability.

Results
The average cost of splints for carpal tunnel syndrome on Amazon and eBay are £9 and £8 respectively, and £15 on Amazon and £10 on eBay for cubital tunnel syndrome. We found that all top 5 hand splints found on these websites are suitable for the conditions they advertised. The average time for free delivery of splints is 2 days for Amazon and 3 days for eBay. Splints are easily sized by using the sellers wrist/elbow circumference measurement guide.

Conclusions
This study has given us the confidence to encourage patients to purchase splints, at an affordable price, from online sites whilst either waiting for specialist appointments or as part of their specialist recommended treatment. With early initiation of treatment, patients may have symptomatic relief and, in some cases, avoid the need for further treatment, leading to reduced hospital footfall.