bluuebunny/crossref_metadata_2025_split huggingface dataset:
793 The Giant Hogweed as A Rare Cause of Chemical Burns: A Case Series
Authors: Lim S K , Clements J , Khan K 
Published: May 2021

Abstract

Introduction
The Giant Hogweed (Heracleum mantegazzianum) is a rare cause for chemical burns in humans and animals and is acquiring growing recognition in mainstream media as a relevant public health concern.
Injuries attributed to this plant range from innocuous superficial irritation to full-thickness chemical burns. A vast majority of cases will resolve with conservative measures and effective first aid, but these case series demonstrate the clinical course of more severe injuries.

Description
We present a case series of 2 patients requiring admission to the Royal Group Hospitals for management of mixed thickness hogweed burns. Injuries were sustained by two separate infestations of giant hogweed in the Western Trust Area. Both patients responded to observation and conservative measures, namely effective analgesia, UV light protection, topical hydrocortisone, and dressings.

Discussion
Cutaneous burns induced by giant hogweed are caused by contact with its photoactive sap containing plant furocoumarins. On exposure to sunlight, the sap initiates a damaging process known as phytophotodermatitis (PPD). This process can be managed effectively with topical steroids; however, prolonged contact and subsequent sun exposure may lead to more severe skin damage. In extremely rare instances, damage may progress to full-thickness skin burns warranting operative intervention.
807 A Review of The Applications of Autologous Fascia Lata Grafts in Reconstructive Surgery
Authors: Baldwin A , Lahiri A 
Published: May 2021

Abstract

Background
We sought to review current applications of fascia lata autografts and update the original collection of uses proposed almost a century ago, thereby revealing the full extent of uses available to the contemporary reconstructive surgeon.

Method
A comprehensive literature search of peer-reviewed articles listed within PubMed and Medline was performed.

Results
The properties of autologous fascia lata grafts are presented, a technique for its harvest and the numerous uses of this material in reconstructive surgery. Specifically, its applications in head and neck surgery, surgery of the limbs, abdominal wall reconstruction and penile reconstruction are reviewed.
There is limited data on donor site morbidity, but complications appear to be uncommon. However, it was established that the reported risk of muscle herniation varies greatly in the available literature from 0-36% and appears to be related to the width of tissue harvested.

Conclusions
Autologous fascia lata grafts are a viable and versatile material in the armamentarium of a reconstructive surgeon, that, with careful planning, can be used with minimal donor site morbidity. This is especially true in lower resource settings where a surgeon may not have access to allogenic material and autologous grafts can provide an easily accessible, cheaper, and practical alternative.
830 Why We Should Be Looking for A Diagonal Ear Lobe Crease In ENT. A Meta-Analysis of Diagonal Ear Lobe Crease and Coronary Artery Disease
Authors: Curtis J , Walford S 
Published: May 2021

Abstract

Introduction
An association between a diagonal ear lobe crease (DELC) and cardiovascular disease, was first suggested by Sanders T. Frank in 1973(1). Since then, there have been numerous further studies that have investigated the association of ‘Frank’s Sign’ with carotid disease, cerebral vascular disease, and diabetic retinopathy. This review looks to see if there is a significant association between the presence of a DELC and coronary artery disease (CAD).

Method
Meta-analysis of selected studies, published between 1974 and 2017, using the PRISMA checklist(2).

Results
We included 12 studies in the pooled analysis, which included 2415 cases and 2545 controls. Our study found that patients with DELC, have an increased likelihood of having CAD (OR 4.61). Also, despite some previous studies suggesting that DELC was simply a result of age, all ten of the included studies that looked at this found that the relationship between DELC and CAD was independent of both age and other known cardiovascular risk factors.

Conclusions
We found that DELC is associated with CAD independently of other known cardiovascular risk factors, including age. Patients with DELC appear to have a substantially increased risk of CAD, and this may be higher for patients with bilateral DELC.
863 Peri-Implant Fluid Collection in Breast Reconstruction and Aesthetic Surgery
Authors: Karagiannidis G , Mallidis E 
Published: May 2021

Abstract

Introduction
Peri-implant fluid more than 6 months from surgery is a known complication of breast surgery.Differential diagnosis includes infection, inflammation,implant rupture and haematoma.Other than infection raised no concern until the identification of Breast Implant Associated Anaplastic Large Cell Lymphoma(BIA-ALCL).

Method
Retrospective electronic data collection for women 18 years or older who met the following inclusion criteria:(a)oncoplastic and/or cosmetic reconstructive surgery with placement of implant(b)peri-implant fluid collection after 6-36 months.

Results
In total,17 women with implants with a mean age of 56 years were included in the study.The mean time between reconstructive surgery and the peri-implant fluid collection was 23 months.The median peri-implant fluid collection size was 143 ml.14 of the 17 peri-implant fluid collections were benign.12 of 14 had polyurethane-coated textured implants.4 of the 17 were BIA-ALCL.

Conclusions
The current literature suggests that late peri-implant seromas arise from friction as the implant moves within the cavity and that this friction is increased with textured rather than smooth implants.In our unit 12/14 of the benign collections appeared in reconstructions with polyurethane implants.Furthermore,BIA-ALCL should always be considered in this situation and aspirate should be sent for cytology.Is this change in polyurethane implants a new entity?
870 Early Weight Bearing In &gt; 60 Years - Is It All A Dream?
Authors: Kapoor S , Choudhry B , Ahmed M 
Published: May 2021

Abstract
Background: Early weight bearing (EWB) is increasingly considered acceptable in surgically managed fractures. However, there are two different outlooks for rehabilitation. EWB in a biologically weak bone may lead to implant failure compared to EWB being beneficial for quicker recovery. We aim to review outcomes for EWB in surgically managed fragility fractures.
Method: This was a retrospective analysis; data was collected from departmental records of operative fixation of lower limb injuries in patients above 60 years. We excluded patients who had procedures for proximal femoral fractures and polytrauma. We compared SF-12 scores, complications, and reoperation rates in those that were EWB to those that were at the conventional 6-week mark.
Results: During a 6-month period from November 2019 to April 2020 we performed 60 operations. N = 30 surgeries were performed in EWB group versus 30 surgeries in late weight bearing group (LWB). The average physical and mental SF-12 score in EWB group was 44.82 and 56.36 compared to a SF-12 score of 44.51and 52.18 in LWB.

Conclusions
We found that the SF-12 scores were different despite EWB. There was no evidence of early complications in the EWB group. Therefore, we advocate EWB for group &gt;60 who were known to have osteoporosis.
876 A Sweeping Success – Management of Type 1A Endoleak Using A Chimney Graft Technique
Authors: O'Sullivan M , Wood P , Kavanagh E , Moloney T 
Published: May 2021

Abstract
Endoleak is a recognised complication after Endovascular Abdominal Aortic Aneurysm Repair (EVAR). In the setting of a rapidly expanding aneurysm – time is of the essence. Perfusion of the renal arteries, superior mesenteric artery (SMA) and coeliac artery must be maintained. To facilitate this a customised fenestrated endograft may be used or a chimney endovascular aortic repair (CHEVAR).
A 78-year-old female initially underwent EVAR in 2016 for a ruptured 6.9cm AAA. She made a good recovery at that time. She was enlisted in a surveillance programme. Her most recent duplex showed an aneurysmal sac of 10cm with associated type 1A endoleak. Given these findings waiting for a fenestrated graft posed an unacceptable delay. She underwent a CHEVAR with bilateral axillary and right femoral access. She had chimney stents deployed in the renal arteries and SMA with aortic cuff extension proximally. Her completion angiogram showed good proximal seal with patent stents. She was unexpectedly unstable post-operatively and had a CT scan which revealed a re-ruptured aneurysm. She was treated in ICU and recovered well. Repeat imaging showed good flow in all 4 grafts with no endoleak.
This case demonstrates the challenges of managing endoleak post EVAR and the importance of robust surveillance and appropriate, timely treatment.
924 The Effect of COVID On the Skin Cancer Referral Pathway
Authors: Ali S , Dunne J 
Published: May 2021

Abstract

Introduction
Due to COVID resulting in all elective surgeries being cancelled; it was thought that patients with suspected skin cancer maybe seeing a specialist and having surgery later than. So, to tackle this as lockdown occurred, the Plastic Surgery department at Charing Cross Hospital secured a minor operation room in outpatients, to keep treating suspected skin cancer. But did it work?

Method
Data was collected from an interval of 2 months before the pandemic (December-January) and 2 months post the pandemic (April-May). Each suspected skin cancer patient who was put on the two weeks wait referral during that time had their receipt of referral, first appointment with a specialist and date of surgery (if that was done) recorded.

Results
Before COVID 81% of patients were seen by a specialist in 2 weeks compared to 89% after COVID. Also, 78% of patients had achieved surgery within 62 days before the pandemic, compared to 86% after the pandemic.

Conclusions
In conclusion, the results showed that the implementation of the minor operation room at short notice enabled the department to meet capacity. Thus, it is utilisation going forward can improve how quickly skin cancers are managed.
942 Cost Effectiveness of Percutaneous EVARs Compared to Standard Cut Down
Authors: Zaki S , Hossack M , Makar R 
Published: May 2021

Abstract

Introduction
Percutaneous EVAR (PEVAR) is gaining popularity worldwide. Our aim is to identify whether PEVAR is cost effective compared to open access.

Method
We retrospectively identified patients undergoing EVAR for unruptured AAA over a 4-year period (April 2014- December 2018). Demographic, procedural, and financial data were collected. Exclusion criteria were complex EVARs and EVARs with planned adjunct procedures. Outcome measures were length of stay (LOS), number of Perclose devices used, number of failures, need for adjuncts, theatre time used, and total cost of each.

Results
318 patients (88.4% male) underwent EVAR between January 2015 and October 2018, average age 76.9 years and median maximal aortic diameter 60mm. 61 EVARs were planned for open access, and a sample of the latest 92 consecutive PEVARs were selected to prevent bias. The median LOS following PEVAR was 1 day less (2 vs 3 days). Mean Proglides used were 5. 2.7% of devices failed, and no surgical cut-down was required in this cohort. Mean theatre time used for PEVAR was 179 minutes vs 213 minutes for open access. All considered, PEVARs cost £124 less.

Conclusions
PEVAR is associated with a shorter length of hospital stay and is more cost effective than open access.
947 Mycotic Pseudoaneurysm Of the Common Carotid Artery: A Rare Neck Lump
Authors: Kenyon O , Tanna R , Sharma V , Kullar P 
Published: May 2021

Abstract
Mycotic pseudoaneurysms are rare, potentially fatal arterial wall infections of either fungal or bacterial origin. The estimated incidence is 20 cases/decade. Trauma is the commonest cause and in 25% the cause remains unknown.
A 62-year-old man presented with a three-week history of a non-tender enlarging neck lump associated with hoarseness of voice. He was apyrexial with no stridor nor dysphagia. The lump measured 10x10cm at levels II-III on the left side of the neck with no overlying erythema. After normal oral examination, flexible nasendoscopy revealed a left-sided pharyngeal swelling occluding 25% of the airway. He was commenced on intravenous antibiotics and steroids. A contrast enhanced CT demonstrated a mycotic pseudoaneurysm of the left common carotid artery (CCA) with a linear foreign body exiting the oesophagus. He underwent emergency surgery with the vascular team to excise 3cm of unhealthy CCA with long saphenous vein graft repair. Neck exploration and panendoscopy found no further defects including no foreign body. He made an excellent recovery and is awaiting an injection thyroplasty to manage his complete left vocal cord palsy.
Although rare, vascular injury and subsequent pseudoaneurysm is an important differential and should always be considered in those presenting with neck swelling.
948 Visceral Artery Aneurysms- A Single Centre Experience Over 6 Years
Authors: Zaki S , Ashrafi M , Balakrishnan A 
Published: May 2021

Abstract

Introduction
The incidence of visceral artery aneurysms (VAA) varies from 0.01-0.1%. They are significant with a mortality risk of up to 75% if ruptured. Given there are no national guidelines we decided to conduct this study to assess the management of VAA in our trust and recommend local guidelines.

Method
We retrospectively identified patients who had a detected VAA between April 2014 and April 2020. Medical records and relevant imaging were reviewed in detail. MDT outcomes and subsequent mortalities noted.

Results
We identified 62 VAA in 59 patients (23 male), median age 65 years, and mean diameter 18.1 mm. 95 % were detected on CT, the indication was mostly malignancy. MDT outcomes were to continue surveillance for 43 patients with yearly scans, 5 patients had primary surgical repair, 7 patients had endovascular interventions, 1 patient had primary endovascular intervention that failed and required surgical intervention. 7 patients were discharged from follow up due to age and size (12 mm) or VAA completely thrombosed.

Conclusions
In our unit decisions to intervene were based on size &gt; 20mm, rapid increase in size on surveillance, the presence of portal hypertension or possibly the patients’ young age. There were no mortalities linked to VAA.
974 Paget-Schroetter Syndrome in A Young Fitness Enthusiast with A Negative D-Dimer. Highlighting the Balance Between Clinical Suspicion and Diagnostic Modalities
Authors: Gani A , Lucas G , Ellis C , El-Karim A , Refson J 
Published: May 2021

Abstract
This case illustrates an athletic 22-year-old, who presented to the hospital with a 3-week history of spontaneous right arm ache, discolouration and swelling. His blood tests were normal, with a negative D-dimer (&lt;150ng/ml). He underwent a CT venogram for suspicion of venous obstruction which was unremarkable. However due to a high clinical suspicion, an ultrasound doppler was performed. This identified the presence of axillary-subclavian thrombosis which in conjunction with other clinical and radiological parameters confirmed the diagnosis of Paget-Schroetter Syndrome (PSS). Our patient was commenced on anticoagulation as the venous obstruction was suspected to be sub-acute with clinical suggestion of collateral formation. Unfortunately, his symptoms failed to resolve over a 6-month period, and he underwent an elective right rib resection with right subclavian bypass using the great saphenous vein with good outcome post-operatively.
PSS is a rare manifestation of venous thoracic outlet syndrome (TOS) commonly seen in young, healthy, athletic individuals. Despite the high effectiveness of D-Dimers in ruling out acute thrombotic process and the accuracy of dedicated CT angiography in excluding vascular thrombotic events, both tests proved inconclusive in this particular case. This latter observation highlights the importance of the clinical context, and risk profiling in guiding results interpretation.
983 Patient’s Satisfaction of Virtual Clinics for Post-Cardiothoracic Surgery Follow Up During COVID
Authors: Durand-Hill M , Ikenna Ike D , n Bhardwaj Shah A , Nijhawan Aditi , Smith Alex , Shipolini Alex , Stamenkovic Sasha 
Published: May 2021

Abstract

Introduction
With advances in technology, virtual clinics are becoming increasingly attractive as a tool for outpatient follow up care. During the COVID-19 pandemic, the implementation of virtual outpatient clinics was crucial, for continued service provision despite social distancing guidelines. We aimed to ascertain patient satisfaction with virtual clinics in cardiothoracic surgery.

Method
Forty patients who attended virtual clinics, post cardiothoracic surgery, were invited to provide feedback by means of a questionnaire. Feedback was gathered by junior doctors.

Results
Thirty-four patients (20 had never had a telephone clinic appointment) agreed to provide feedback. Fifty percent of patients had not been seen since their operation. 91.2% (n = 31) of patients felt that the telephone consultation met their expectations/needs. Patient reported advantages of telephone consultations included: less concern regarding exposure to infection, no concern regarding parking, no travel time and less time off work. 79.4% (n = 27) would have preferred a face-to-face appointment. Patient reported disadvantages of telephone consultations were poor reception, felt they weren’t listened to and would have preferred to have been physically examined.

Conclusions
Patients were satisfied with telephone clinics for routine follow up post cardiothoracic surgery. However, the majority would have preferred face to face appointments.
995 Clinical Outcomes Following Incomplete Colonoscopy
Authors: Khan K S , McCulloch C 
Published: May 2021

Abstract

Introduction
Following incomplete colonoscopy (IC) it is reported that there is up to ﬁve-fold increased risk of colorectal cancer. Our aim was to determine the ﬁnal clinical outcome for patients with a prior IC.

Method
A multi-centre retrospective observational study involving three endoscopy units. All consecutive patients having colonoscopy from over 18 months were analysed. Exclusion criteria included IC was due to obstructing cancer, follow up was not performed due to non-attendance at clinic or investigation and incomplete data set. Electronic notes were analysed to determine patient’s ﬁnal clinical outcome. All patients were followed up for minimum of six months.

Results
Of the 8,490 colonoscopies, 733 (8.6%) were IC. 86 (11.7%) were excluded. Of the 647 included, 469 (72.4%) were females and 473 (73.1%) has further colonic investigations. Secondary investigations were: CT colonography 169 (35.7%), repeat colonoscopy 161 (34.0%), barium enema 95 (20.1%) and others 48 (10.1%). The repeat colonoscopy group achieved a complete colonoscopy in 111 (68.9%) patients. For those who had further investigations 15 (3.2%) had colorectal cancer and 12 (2.5%) has polyps ≥1cm.

Conclusions
There is significant risk of missing colorectal malignancy and large polyps following IC. Further colonic investigations should be carried out in this cohort of patients.
1023 The Role of Social Media in Disseminating Plastic Surgery Research: The Relationship Between Citations, Altmetrics and Article Characteristics
Authors: Grant M , Scott-Bridge K , Wade R 
Published: May 2021

Abstract

Background
Social media (SoMe) enable the dissemination of content immediately and directly to interested end-users. Alternative metrics (altmetrics) are non-traditional bibliometrics which describe the exposure and impact of an article on freely available platforms such as Twitter and Facebook. Altmetrics within days of publication are associated with ultimate citation counts in various medical disciplines, except plastic surgery which represents the rationale for this study.

Method
Altmetric explorer was used to extract altmetrics and citation rates for articles published during 2018 in Plastic and Reconstructive Surgery (PRS), the Journal of Plastic, Reconstructive and Aesthetic Surgery, the Annals of Plastics Surgery and Plastic Surgery. Multivariable negative binomial regression was used to estimate the relationship between citations and predictors (presented as the incidence rate ratio, IRR with 95% confidence interval, CI).

Results
Overall, 1215 articles were captured. On average, articles published in PRS were cited nearly five times as often as articles published elsewhere (adjusted IRR 4.77 [95% CI 2.36, 9.62]). Overall, SoMe mentions were positively associated with citation rates (adjusted IRR 1.01 [95% CI 1.01, 1.1]); marginal analysis showed that 45 mentions translated to one extra citation.

Conclusions
Dissemination of plastic surgery research through SoMe channels are associated with significant improvements in short term citations rates.
14 Orthopaedic Post-Operative Elective Proforma
Authors: Castelhano R , Kakkar V 
Published: May 2021

Abstract

Introduction
Post-operative daily reviews are essential for a safer post-op recovery and must recognise, early, potential complications and prevent their advance. The fast turnover of Junior Doctors and often T&O being their first surgical rotation, leads to a decrease in knowledge of which aspects are important to assess in a post-op patient. The aim of this project was to create a proforma that helps in assessing elective post-op patients and reduce mistakes.

Method
QI methodology was applied and a proforma was created and made available in every set of notes of elective patients. Awareness was raised about the proforma which was done at the time of the induction of the new doctors which corresponded to separate PDSA cycles.

Results
Following cycle 1, the adhesion was 98%. VTEP, analgesia, Xray reviewed, examinations were documented in 100% of the patients. The PDSA cycle 2 coincided with the new incoming doctors, despite the efforts, there was poor compliance. The notes were reviewed: VTEP, analgesia and examination were not documented, post-op x-rays were reviewed in 60%.

Conclusions
The PDSA cycle 2 showed how the proforma increases patient safety with good documentation and should continue to be used by the Department.
23 Reaudit and Completing the Audit Cycle of Quality of Informed Consent for Surgery on Neck of Femur Fracture in Royal Stoke University Hospital
Authors: Khaleeq T , Hanif U , Maqsood Y , Ahmed K , Patel A 
Published: May 2021

Abstract
Using guidelines highlighted by the British Orthopaedic Association an reaudit was performed within our department to assess the adequacy of informed consent for NOF fractures to complete the audit cycle. 50 patients were included in the Audit and reaudit. Risk was classified as common, less common, rare and ‘other’. The adequacy of informed consent was evaluated by assessing the quality and accuracy of documentation. Infection, bleeding risks, clots and anaesthetic risks were documented in all patients (100%). Areas of improvement were seen in the documentation of neurovascular injuries (98%), pain (90%) and altered wound healing (87%). There was no significant change in the documentation of failure of surgery (83%) and neurovascular injuries (98%). The Poorly documented risk factors from the initial audit were seen to improve which included mortality (70%), prosthetic dislocation (90%) and limb length discrepancy (50%). There has been a significant improvement in the quality of Informed consent in the department and this could be attributed to the installation of ward posters and verbal dissemination of information to junior doctors. Recommendation for interventions would be to present in the next clinical governance meeting and presenting at the new junior doctors’ induction at August.