Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases

Abstract Background: NOMA is a significant yet neglected disease which affects children in some of the least developed countries in the world. Surgical reconstructive missions for patients affected by NOMA are undertaken regularly by surgeons from more developed countries. However, the long-term benefit and safety of these missions have recently been criticized due to a perceived lack of measurable outcomes and appropriate follow-up. We are conducting a systematic review to critically evaluate the classification systems, outcome measurement tools, and follow-up periods reported in the literature for NOMA disease. Methods: This systematic review is undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (“PRISMA”) guidelines. The databases MEDLINE, Embase and Web of Science are searched from infinity to 24th of April 2019. All original publications of studies undertaken on reconstructive surgery for NOMA disease, reporting data on outcome after surgery, follow-up time and complications are eligible for inclusion. The primary outcome of interest are the outcome measurement methods used for assessing successful reconstructive surgery after NOMA disease. Other outcomes we are assessing are methods for classification of disease severity and time to last follow-up. The quality of evidence for each summary outcome measure is assessed using the MINORS criteria. Discussion: Given the precarious situations in the countries where mission surgeons often undertake reconstructive surgery, time pressure and the lack of infrastructure on site prevent them from being able to measure the effect of their surgical outcomes. Our goal is to express the key points of debate and make recommendations for how future surgical missions can be improved. We aim to do so by comparing the current best standards of practice Publishing this protocol will help future NOMA surgeons plan their missions in a standardised and reproducible way, striving towards a future of worldwide high-quality research.Systematic review registrations: This protocol was submitted to PROSPERO on the 02.10.2020 and is currently under assessment. (ID 181931)

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Quality of life and reconstructive surgery efforts in severe hand injuries

Innovative Surgical Sciences ◽

10.1515/iss-2018-0002 ◽

2018 ◽

Vol 3 (2) ◽

pp. 147-156 ◽

Cited By ~ 1

Author(s):

Seyed Arash Alawi ◽

Dennis Werner ◽

Sören Könneker ◽

Peter M. Vogt ◽

Andreas Jokuszies

Keyword(s):

Quality Of Life ◽

Reconstructive Surgery ◽

Total Duration ◽

Life Quality ◽

Hand Injuries ◽

Surgical Reconstruction ◽

Reconstruction Process ◽

Total Period

AbstractIntroduction:Severe hand trauma, leading to extensive skeletal and tissue defects, requires plastic surgical reconstruction of the highest level aiming at maximizing function and aesthetics. The intention of this study was to investigate clinical parameters and resource consumption connected with severe hand injuries, with specific emphasis on a follow-up evaluation of quality of life after the reconstruction process.Materials and methods:In this retrospective study, we evaluated patients with severe hand injuries from 2013 to 2016 who had completed surgical and non-surgical treatment. Measures included total period of therapy (TPT) in days, total duration of operations including anesthesia (TOA), total duration of all operations (TO), and total number of operations (TNO). We also determined total inpatient stay (TIS), total number of clinic presentations with interventions (TNPI), initial hand injury severity score (iHISS), and inpatient proceeds (IPP) in Euros (€). Correlation was assessed between iHISS and TOA, TNO, and TIS. Finally, these patients were reexamined in a follow-up inquiry and the life quality was assessed with the five-level version of the EuroQol five-dimensional (EQ-5D) descriptive system (EQ-5D-5L).Results:We analyzed 12 patients with an average age of 44 years (min. 24 years, max. 75 years). Patients receiving reconstructive surgery experienced median (${\rm{\tilde x}}$) TPT of 175 days [interquartile range (IQR), 51–499], TOA of 13 h (IQR, 6–37), TO of 9 h (IQR, 4–25), and TNO of 5 (IQR, 3–11). Further, the patients’ median TIS was 22 days (IQR, 9–86), TNPI was 4 (IQR, 2–8), and iHISS was 77 (IQR, 44–162). The median IPP was 14.595 € (IQR, 5.541–33.709 €). IHISS was positively correlated with Pearson’s r for TIS (0.817), TOA (0.857), and TNO (0.871). The EQ-5D-5L index value resulted in a high level of life quality with a median of 0.898 (min. 0.8, max. 1).Conclusion:Severe hand injuries are related to high efforts for surgical and functional reconstructions, which result in high quality of life measured with the EQ-5D-5L assessment. However, for a defined collective of patients, myoelectric prosthetic functional replacement should be considered. Further studies are necessary to examine functional outcomes and quality of life after bionic prosthetic replacement. Also, a bionic reconstruction score to define hard criteria for taking an acute treatment decision is necessary.

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Surgical management of an isolated symptomatic talonavicular coalition: a paediatric perspective

BMJ Case Reports ◽

10.1136/bcr-2021-243761 ◽

2021 ◽

Vol 14 (11) ◽

pp. e243761

Author(s):

Keval Patel ◽

Abdullah Khawaja ◽

Aman Patel ◽

Michail Kokkinakis

Keyword(s):

Paediatric Patient ◽

Reconstructive Surgery ◽

Bone Grafting ◽

Iliac Crest ◽

Early Stage ◽

Operative Management ◽

Lateral Column ◽

Iliac Crest Bone Grafting ◽

Lateral Column Lengthening

Talonavicular (TN) coalition is a rare pathological union of the talus and navicular bones. We report the case of a 7-year-old girl with a symptomatic TN coalition, who underwent operative management with a lateral column lengthening procedure using autologous iliac crest bone grafting. There are no complications to report and the graft was incorporated at an early stage. At 3 year follow-up the patient has remained pain-free since the operation and maintained alignment. To our knowledge, this is the first reported case of TN coalition treated with reconstructive surgery in a paediatric patient.

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Use of human fibrinogen and human thrombin for urethral reconstructive surgery

Urologia Journal ◽

10.1177/039156030807500109 ◽

2008 ◽

Vol 75 (1) ◽

pp. 49-53

Author(s):

G. Romano ◽

M. De Angelis ◽

G. Barbagli

Keyword(s):

Reconstructive Surgery ◽

Saline Solution ◽

Selection Criterion ◽

Massive Bleeding ◽

Bleeding Events ◽

Human Fibrinogen ◽

Human Thrombin ◽

End To End ◽

Urethral Reconstructive Surgery

The objective of the present study is to test the use of a haemostatic sponge for urethral reconstructive surgery and to assess the relevant benefits. Methods. The haemostatic sponge is made up of collagen with human fibrinogen and human thrombin. When the sponge gets in contact with fluids, such as blood, lymph or saline solution, the fibrinogen and thrombin are activated and form a fibrin net able to achieve local haemostasis and tissue regeneration. This kind of product was used in 30 selected patients (pts.), aged 19 - 70 (mean age: 35), who underwent single-stage anastomotic urethroplasty from January 2006 to March 2007: 22 bulbar end-to-end anastomoses and 8 bulbo-prostatic anastomoses. All operations were performed due to post-traumatic stricture of bulbar and posterior urethra. The main selection criterion for the use of the haemostatic sponge has always been the tendency to and/or the presence of bleeding in the different surgical stages. The sponge imbibed in saline solution and suitably modeled for all specific requirements was differently placed: sleeve-shaped in the case of bulbar anastomoses (16 pts.); as a “patch” in the centre of spongioplasty in bulbo-prostatic anastomoses (8 pts.), and within the widening incisions of the urethral roof performed between the two cavernous bodies at level of the intercrural septum (5 pts.). In 1 case (obese patient) a single sponge was placed after the deep perineal reconstruction on the bulbo-cavernous muscle-subcutaneous layers because of massive bleeding. Results. In all cases a perfect control of haemostasis could be achieved, with immediate end of bleeding in the points where the haemostatic sponges were used. The dressings performed on day 3 upon removal of the compressive scrotum-perineal bandages did not show any late post-operative bleeding. The follow-up visits at month 1 and 3 yielded positive outcomes for all 30 patients, who achieved complete wound healing by first intention, and a perfect anastomosis especially in the bulbar end-to-end urethroplasty, confirmed by urethrografy at one month. Conclusions. The association of human fibrinogen and human thrombin in haemostatic sponges represents a manageable, useful product, apparently sure, not negatively interfering in repairing and regenerating tissue processes, and allowing a simple and direct control of important bleeding events occurring during urethral reconstructive surgery as well as other operations. It is therefore advisable to more widely use the product after a suitable follow-up period.

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It is good to feel better, but better to feel good: whether a patient finds treatment ‘successful’ or not depends on the questions researchers ask

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-100260 ◽

2019 ◽

Vol 53 (23) ◽

pp. 1474-1478 ◽

Cited By ~ 4

Author(s):

Ewa M Roos ◽

Eleanor Boyle ◽

Richard B Frobell ◽

L Stefan Lohmander ◽

Lina Holm Ingelsrud

Keyword(s):

Exercise Therapy ◽

Reconstructive Surgery ◽

Treatment Strategies ◽

Acl Injury ◽

Important Change ◽

Minimal Important Change ◽

Cross Sectional ◽

Patient Reported ◽

Randomised Controlled

IntroductionIn sports physiotherapy, medicine and orthopaedic randomised controlled trials (RCT), the investigators (and readers) focus on the difference between groups in change scores from baseline to follow-up. Mean score changes are difficult to interpret (‘is an improvement of 20 units good?’), and follow-up scores may be more meaningful. We investigated how applying three different responder criteria to change and follow-up scores would affect the ‘outcome’ of RCTs. Responder criteria refers to participants’ perceptions of how the intervention affected them.MethodsWe applied three different criteria—minimal important change (MIC), patient acceptable symptom state (PASS) and treatment failure (TF)—to the aggregate Knee injury and Osteoarthritis Outcome Score (KOOS4) and the five KOOS subscales, the primary and secondary outcomes of the KANON trial (ISRCTN84752559). This trial included young active adults with an acute ACL injury and compared two treatment strategies: exercise therapy plus early reconstructive surgery, and exercise therapy plus delayed reconstructive surgery, if needed.ResultsMIC: At 2 years, more than 90% in the two treatment arms reported themselves to be minimally but importantly improved for the primary outcome KOOS4. PASS: About 50% of participants in both treatment arms reported their KOOS4 follow-up scores to be satisfactory. TF: Almost 10% of participants in both treatment arms found their outcomes so unsatisfactory that they thought their treatment had failed. There were no statistically significant or meaningful differences between treatment arms using these criteria.ConclusionWe applied change criteria as well as cross-sectional follow-up criteria to interpret trial outcomes with more clinical focus. We suggest researchers apply MIC, PASS and TF thresholds to enhance interpretation of KOOS and other patient-reported scores. The findings from this study can improve shared decision-making processes for people with an acute ACL injury.

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Woakes’ syndrome

BMJ Case Reports ◽

10.1136/bcr-2018-229021 ◽

2019 ◽

Vol 12 (3) ◽

pp. e229021

Author(s):

Mohamed Mehdi El Fakiri ◽

Youssef Lakhdar ◽

Abdelaziz Raji

Keyword(s):

Local Treatment ◽

Sinus Surgery ◽

Self Medication ◽

Therapeutic Protocol ◽

History Of ◽

Nasal Pyramid ◽

Endoscopic Sinonasal Surgery ◽

Adequate Management ◽

Sinonasal Polyposis

Woakes’ syndrome is a rare entity defined as recurrent sinonasal polyposis with a consequent nasal pyramid deformity. Only a few cases are reported in the literature. The goal of this study is to present the features of Woakes’ syndrome through a clinical case. A 42-year-old man presented with a history of ASA triad. He started self-medication for 5 years. He returned to the otorhinolaryngology department for the aggravation and persistence of symptoms. CT scans showed the deformity and thinning of the nasal bones. A functional endoscopic sinus surgery and correction of nasal pyramid deformity were performed. At 6 months' follow-up, good functional and aesthetic outcomes were observed. Woakes’ syndrome was described more than 130 years ago. Treatment includes endoscopic sinonasal surgery and local treatment. Adequate management and good adherence to the therapeutic protocol could be factors to prevent this syndrome.

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