bluuebunny/crossref_metadata_2025_split huggingface dataset:
19 10 Years of Tertiary Paediatric Centre Experience of Females Undergoing Surgery for Ovarian Torsions
Authors: Fryer S 
Published: October 2021

Abstract

Aim
Review role and accuracy of imaging, and subsequent management, of patients with ovarian torsion managed at a tertiary paediatric centre.

Method
Retrospective review of notes for patients undergoing surgery for ovarian torsion over 10 years (2010-2019).

Results
23 patients underwent surgery for ovarian torsion (one excluded due to lack of data). Median age 12 years[range 1-15]. 18/22 patients underwent imaging; 15/18 had USS, 12/15(80%) were diagnostic for ovarian torsion. 3/15 showed ovarian pathology prompting further imaging/surgery. 2/22 had initial MRI, 1 diagnostic for torsion. Time from symptom onset to surgery was assessed, data was incomplete for 4 patients. 10 patients were referred from ED/primary care; 5(50%) underwent theatre within 12 hours, 3(30%) 12-12hours and 2(20%) &gt;24hours. 8 patients were referred from external hospitals; 2(25%) underwent theatre within 12 hours, 4(50%) 12-12hours and 2(25%) &gt;24hours. Those having surgery&gt;24 hours from symptom onset were awaiting imaging or had suspected other pathology. 4/22 underwent oophorectomy (open:laparoscopic=3:1) and 18/22 had detorsion +/- cyst aspiration/excision (open:laparoscopic:converted=2:15:1). Follow up imaging was performed in 13/18 patients who underwent detorsion and 2/5 who underwent oophorectomy. Of 3 patients undergoing oopherectomy who did not have follow up; 2 had benign cysts and 1 had a simple tubo-ovarian torsion.

Conclusions
We advocate early USS in females with presentation concerning for ovarian torsion, though a high index of suspicion is often required owing to non-specific symptoms. Imaging and transfer should be performed promptly to prevent delays in surgical management.
671 Fetus-In-Fetu Found at Excision of An Antenatally Diagnosed Abdominal Mass: Multi-Disciplinary Approach
Authors: Smith K , Moore A , Popov S , Adams M , Folaranmi E , Sekaran P 
Published: October 2021

Abstract
We present a case of antenatally detected abdominal mass and an alternative diagnostic course for suspected neonatal neuroblastoma as a result of investigative findings. A female infant presented antenatally with a left upper quadrant mass initially managed as a suspected neonatal neuroblastoma; further cross-sectional imaging suggested a wider differential including teratoma and aided surgical planning. The multi-disciplinary team (MDT) decision was for an early excision at 31 days and post-operative histology identified a diagnosis of fetus-in-fetu (FIF). We describe this case as a compliment to the current literature and an example of a necessary variation to recognised diagnostic and treatment pathways as a result of investigative findings.
745 Prospective Evaluation of Virtual Consultations in Paediatric Surgery and Urology: Lessons from the Pandemic Times
Authors: Awolaran O , Robotin-Pal A M , Douglas K , Sheth J , Kalidasan V 
Published: October 2021

Abstract

Aim
Virtual consultation (VC) became the new norm for providing outpatient clinics during the COVID-19 pandemic. This is likely to be adopted in some form going forward. This study prospectively evaluated the effectiveness&safety of VC undertaken at a UK tertiary paediatric surgical centre during the pandemic.

Method
Data on paediatric surgery/urology outpatient video/telephone consultations between May-June 2020 was prospectively collected. VC episodes were given outcomes (1,2or3) depending how well surgeons were able to make definitive diagnoses/plans. 6months later, findings at later face-to-face visit were retrospectively compared with earlier VC to assess accuracy of decision-making using VC. Telephone survey of patient experience was done.

Results
186VC were evaluated. 95 (51%) were paediatric general surgical patients and 91 (49%) urology. 118 (63%) were follow-ups and 68 (37%) new. In 70% of cases, clinicians were able to make definitive diagnosis/plan using VC (outcome1) while 26% could be delayed till face-to-face consultation is safe (outcome2). 7 patients (4%) needed to be brought in urgently (outcome3). Clinicians were significantly more able to make definitive diagnosis/plan in urology and follow-up patients. Of those brought back for scheduled follow-up/surgery, there was 93% correlation between findings at physical consultation compared to the definitive plans made at VC. Patient survey showed 92% overall satisfaction rate. 75% felt VC is comparable to face-to-face/would use VC again.

Conclusions
This study provides evidence that VC is an effective&safe way to structure paediatric surgical outpatient care and it highlights the patient categories in which VC is most suitable.
67 Nutritional Assessment of Patients Admitted To “Adult Burns Unit” At Southmead Hospital from April To August 2017
Authors: Babar M , Katechia D , Sen S , Pleat J 
Published: October 2021

Abstract

Introduction
Nutritional support is an integral part of Burns management. Local guidelines for malnutrition screen are available at Southmead Hospital.

Aim
Audit was aimed at compliance of malnutrition screen for all admissions to “Adult Burns Unit” to the local guidelines.

Method
A retrospective data of baseline and weekly malnutrition screen was collected and analysed for 106 patients between April and August 2017. These findings were compared to the following local guidelines;

Results
Of 106 patients, most (n = 72) had &lt;5% TBSA burn. 9 were resus burns (TBSA &gt;15%). 50 patients stayed less than a week while 34 discharged within 24hrs. 20 stayed longer than seven days. Compliance of recording weight on admission was 46.2% while weekly assessment 10%. Height and BMI were measured for 24.5% of admissions. 81% of patients had admission bloods and 19 out 20 staying longer than a week had weekly bloods. All major burns were referred to dietician.

Conclusions
Assessment of %TBSA, admission and weekly bloods, and dietician referral were areas of good practice. However, compliance with recording weight and height on admission did not meet the Trust target of 85% We recommended a checkbox for weight and height on admission in Trust’s electronic handover system, monitor at weekly burns MDT and re-audit.
107 The Role of Tissue Engineering in Auricular Reconstruction: A Critical Review
Authors: Moura F , Varley R , Yao C 
Published: October 2021

Abstract

Aim
Despite several decades of research in tissue engineering, reconstructing a 3D human-sized ear that can stand the test of time has remained a challenge. Autologous cartilage reconstruction remains the main treatment choice despite the associated morbidity. Progress in the field has been made and several studies have used tissue-engineered implants in immunocompetent animals with promising results.

Method
This study critically reviews and assesses the characteristics that make auricular reconstruction so challenging and how far research has come in addressing the following: mechanical properties; vascularisation; immune response; cell sourcing; surgical attachments; allografts; and cost.

Results
The question is whether tissue engineering will realistically replace autologous cartilage reconstruction in the short-term, or will advances in other areas, outlined in this article, manage to provide suitable and aesthetically accurate scaffolds.

Conclusions
Advances in tissue engineering are slowly progressing and utilise advances in both biomaterial design and 3D bioprinting to try and address the challenges of auricular reconstruction. Tissue engineering is still a promising solution to auricular reconstruction but still requires further research before becoming a reality.
180 Improving Wall Access When Using Double Clamps for Microsurgical Anastomosis – A New Technique
Authors: Faderani R , Ali S , Masud D , Haywood R 
Published: October 2021

Abstract
Microvascular techniques and instrumentation have continually evolved since the advent of clinical microsurgery in the 1970’s. These refinements and improved patient selection have led to increased vessel patency and flap survival rates. However, a fundamental principle which has not changed over this time period is comfort and proper operating microscope set-up. Both these factors were described as a precondition of microsurgical success by the late pioneer of microsurgery himself, Robert Acland. Suboptimal comfort or set-up can negatively impact on access to the surgical field leading to improper technique and if significant enough, anastomotic thrombosis. We describe a new technique aimed at improving wall access when using double clamps for microsurgical anastomosis.
312 Retrospective Analysis of Long-Term Scarring Outcomes in Paediatric Burns Patients
Authors: Mistry R 
Published: October 2021

Abstract

Introduction
Paediatric burns are a common presentation to a plastic surgery unit. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings, in a cohort of paediatric burns patients.

Method
The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the Brisbane Burn Scar Impact Profile (BBSIP), a patient reported outcome measure specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically versus those treated conservatively.

Results
A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically versus those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups.

Conclusions
We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings.
338 Management of Periprosthetic Breast Infection: A Systematic Review and Meta-Analysis
Authors: Arumugam V , Faderani R , Kanapathy M , Singh P , Haque S , Mosahebi A 
Published: October 2021

Abstract

Aim
This systematic review and meta-analysis aims to synthesize the current evidence and establish the efficacy of the various managements of infected breast implants.

Method
A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies reporting on the management of infected breast implants from 1946 to September 2019. The primary outcome measure was the proportion of patients with successful treatment.

Results
Nineteen articles involving 1044 patients were included. Mild infections seen in 29.00%(95%CI=11.51% to 50.58%) of the patients were treated exclusively with antibiotics, of which, 81.41%(95%CI=57.82% to 96.63%) were successfully treated without the need for surgical intervention. Overall, 39.01%(95%CI=21.41% to 58.23%) of the patients underwent surgical salvage of the infected breast implants, of which 84.56% (95%CI= 74.92% to 92.20%) successfully retained the salvaged implants without infection recurrence. Meanwhile, 35.01%(95%CI=27.01% to 43.57%) of the patients underwent explantation of the infected breast implant, of which, only 39.02%(95%CI=23.93% to 55.28%) had re-insertion of a new implant on a later date, and 4.99% (95%CI=1.66% to 9.99%) of these patients had recurrence of infection requiring removal of the infected implant. The commonest complication was capsular contracture, which was reported in 10.78%(95%CI=4.41% to 19.49%) of the patients. Changes in the quality of life and cost implications were not reported.

Conclusions
This study consolidates current available evidence on the management of infected breast implants, which could assist decision making and improve patient education, however current data is limited by the lack of level-1 evidence.
789 New Minor Surgical Set as A Way to Improve Surgical Efficiency During COVID-19 Pandemic
Authors: Eiben I , Eiben P , Bahadori D , Kazzazi D , Simon F 
Published: October 2021

Abstract

Introduction
Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure. Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection.

Method
MS set was introduced to Evelina Theatres and used at senior surgeons’ discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire.

Results
61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation.

Conclusions
NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.
945 Elective Autologous Free Tissue Transfer for Breast Reconstruction During the Covid-19 Pandemic: A Comparative Analysis of Outcomes
Authors: Lafford G , Jeddi S , Masud D 
Published: October 2021

Abstract

Introduction
The demand placed on the National Health Service by Covid-19 has led to increased delays on elective surgery. Despite these challenges, our unit was the first centre in the UK to recommence elective breast reconstruction following the development of an evidence-based pathway to select low-risk patients. An enhanced recovery protocol was introduced to reduce length of stay. The aim of this study was to compare post-operative outcomes between our Pre-Covid group and our Covid-group of free tissue transfer breast reconstruction.

Method
We retrospectively reviewed autologous free tissue transfer breast reconstruction within our department between January 15th and September 27th 2020. Comparative data was split into two groups. A ‘pre-Covid group’ from 15th January to 12th March 2020 and a ‘Covid group’ from 3rd June to 27th September 2020. Both groups contained 15 patients. Operative notes and case notes were reviewed. Length of stay, haematoma-rate, flap failure, infection, fat necrosis, ischaemic time, re-do anastomosis and return-to-theatre were compared.

Results
Average length of stay was reduced from 4 to 3 days amongst our Covid group, haematoma rate was 7% pre-Covid and 13% during Covid. There was no evidence of flap failure, fat necrosis and donor site dehiscence in either group. Infection and flap dehiscence were 7% pre-Covid and 0% during Covid. Re-do anastomosis was 20% pre-Covid and 7% during Covid.

Conclusions
No statistically significant changes in outcomes were identified. This early review suggests that elective breast reconstructive surgery can still be achieved with comparable outcomes, despite the added challenges of Covid-19.
992 Infrared Thermal Imaging in The Diagnosis and Management of Upper Limb Trauma
Authors: Motiwala F , Liu C , Southern S , Jivan S 
Published: October 2021

Abstract

Aim
Trauma can affect perfusion and thereby the temperature of the injured area. Infrared thermal imaging (IRT) has been used as a non-invasive, non-ionising means of diagnosing and monitoring various pathologies. We aim to evaluate the role of IRT in upper limb trauma.

Method
A review of all literature from the Cochrane Database, PubMed, Medline and EMBASE was performed. All papers evaluating infrared thermal imaging in trauma of the upper limb were included. Exclusion criteria included animal or cadaveric studies, and studies not measuring outcomes related to thermal imaging.

Results
Six papers were included from a total of 149 papers. There were five observational studies (with limited population numbers) and one case report. Four studies (N = 217) identified significantly higher skin temperatures in fractured limbs compared to non-injured side (p ≤ 0.05). Two studies included follow-ups with skin temperature differences between injured and non-injured sides decreasing over time, consistent with fracture healing times (approximately 3-4 weeks for paediatrics and 6 weeks for adults). One study (N = 9) identified that the presence of activity-related chronic pain in the hand was consistent with higher mean skin temperatures, even at baseline (p = 0.00000795).

Conclusions
IRT has been successfully used as a means of diagnosis and monitoring fracture healing in the upper limb. It also shows potential for use in detecting fractures that may not be initially evident on x-ray in the acute setting e.g., scaphoid fractures. Further robust and higher quality studies with larger patient populations are required.
1112 The 100 Most Influential Papers in Nail Bed Injury: A Bibliometric Analysis
Authors: Banhidy N , Farhadi S 
Published: October 2021

Abstract

Aim
Nail bed injuries are the commonest paediatric hand injuries. Optimal management is essential to restoring form and function of the nail and fingertip, however high-level evidence of nail bed injury management is lacking, leading to large discrepancies in clinical practice. This paper evaluates the 100 most cited papers in nail bed injury and analyses their study characteristics to assess current research focus and evidence levels.

Method
A Web of Science search was carried out using the search term “nail bed injury”. All article types were included, and no language or publication date restrictions were applied. Results were ranked by overall citation number. All abstracts were screened for study relevance and the top 100 eligible studies were analysed for study type, main study theme, journal, and year of publication.

Result
The three most common study types included retrospective studies (n = 33), literature reviews (n = 25), case reports/series (n = 20). The three main study themes included evaluation of repair techniques (n = 72), aetiology and epidemiology of nail bed injuries (n = 12), and anatomical assessments (n = 7). The most frequently represented journals include Journal of Hand Surgery (n = 30), Plastic and Reconstructive Surgery (n = 7) and Hand Clinics (n = 4).

Conclusions
The most influential papers in nail bed injury are those describing repair techniques. There remains a lack of high level evidence with most papers presenting level 3-5 evidence. This paper demonstrates a continued need for more higher level robust evidence in the field of nail bed injuries.
1243 Sentinel Lymph Node Biopsy for Melanoma during the COVID-19 Pandemic
Authors: Stubley T , El-Khayat B 
Published: October 2021

Abstract

Aim
Sentinel lymph node biopsy (SLNB) is an established aspect of the staging process for primary melanoma, with the results dictating future treatment methods. Due to the COVID-19 pandemic no SLNBs were offered to patients with newly diagnosed melanoma at a hospital site in the West Midlands. The aim of this study was to identify the number of patients who missed out on this investigation in order to ascertain how many patients with a potential positive SLNB were missed.

Method
A patient list was provided from the dermatology and plastic surgery database, ensuring that all newly diagnosed melanoma patients throughout the period March-May 2020 were included. A retrospective study design was utilised, with all data collected from the computer system at a single hospital site.

Results
64 patients were provided via the patient list, of which 44 were appropriate for SLNB using the NICE criteria. After detailed reading of the patient notes, 80% (35/44) of patients were provided with a reason why they did not receive a SLNB, however the remaining 20% (9/44) did not have this clearly recorded.

Conclusions
A large cohort of patients did not receive a SLNB during the COVID-19 pandemic. Utilising the clinical literature, it can be predicted that around 9 of these patients would have had a SLNB that identified metastasis. These patients have potentially missed out on adjuvant treatment, and the cohort will therefore require follow up to be adapted to reflect this.
1312 Characteristics of Those Who Present with Self-Inflicted Burns: A Burns Unit Service Evaluation Which Challenges Stereotypes
Authors: Magness C , Kang M , Kennedy M , Alexander S , O'Boyle C , Hasham S , Shepherd L 
Published: October 2021

Abstract

Introduction
Self-harm rates in the UK are increasing. Healthcare professionals’ beliefs regarding repeat attendance; attention-seeking; and poor treatment compliance may contribute to patients’ stigma. Self-inflicted burns (SIB) constitute a minority of burns cases, but require disproportionate healthcare input, yet little is known about these patients. Our aim was to evaluate presentations, compliance and outcomes in this patient group.

Method
A retrospective audit of outpatients with SIBs attending a UK Burns Unit over four years (Jan 2016-Dec 2019).

Results
Over the study period, 58 patients presented with 94 burn wounds. Incidence doubled over one year (2018-2019). Most patients were female (85%) with a median age of 29 years (range 19-62). The most commonly associated psychiatric diagnosis was personality disorder. On presentation 22% (n = 21) were admitted under the Mental Health Act. For 83% (n = 48) it was their first presentation with a SIB, although 74% had previously presented with non-burn self-harm. Median burn size was 0.5% TBSA, the most common mechanism was contact (48%) and 77% were deep (n = 77). 92% were compliant with treatment and did not tamper with their wounds or dressings.

Conclusions
The majority, 70% (n = 41), of patients only presented once to the Burns Department during the study period. This challenges the commonly held stereotype that those who self-harm will also seek attention through repeat presentation. Ongoing education among health professionals may dispel some myths regarding these individuals. Further, larger investigations, may permit rigorous comparison of treatment outcomes with non-SIB patients.