Preclinical Experiments for Hypospadias Surgery: Systematic Review and Quality Assessment

Background: There is a steadily growing number of different reconstructive surgical procedures for hypospadias that were tested on animal models prior to their human application. However, the clinical translatability and reproducibility of the results encountered in preclinical urethral reconstruction experiments is considered poor, with significant factors contributing to the poor design and reporting of animal experiments. Our objective was to evaluate the quality of the design and reporting in published articles of urethral reconstructive preclinical studies.Methods: Both PubMed and EMBASE databases were searched for animal urethral repair experiments between January 2014 and September 2019. Internal quality (bias) was evaluated through several signaling questions arising from the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE), while the quality of reporting was assessed by the Animal Research: Reporting of In vivo Experiments (ARRIVE) guidelines by scoring of a 20-item checklist.Results: A total of 638 articles were initially screened after the literature search. Employing the inclusion and exclusion criteria, 30 studies were chosen for full-text screening and 21 studies were considered eligible for the quality assessment. The mean score of the checklist was 66%. The elements that accomplished the highest grades included the number of animals utilized, the number in each investigational and control group, and the delineation of investigational conclusions. The items that were least commonly stated comprised information about the experimental method, housing and husbandry, rationalization of the number of animals, and reporting of adverse events. No paper stated the sample size estimation.Conclusion: We found that several critical experiment design principles were poorly reported, which hinders a rigorous appraisal of the scientific quality and reproducibility of the experiments. A comprehensive implementation of the ARRIVE guidelines in animal studies exploring urethral repair is necessary to facilitate the effective translation of preclinical research findings into clinical therapies.

Adherence to Computer-Assisted Surgical Planning in 136 Maxillofacial Reconstructions

ObjectiveTo investigate the adherence to initially planned maxillofacial reconstructions using computer-assisted surgery (CAS) and to identify the influential factors affecting its compliance for maxillofacial reconstruction.Patients and MethodsA retrospective analysis of 136 computer-assisted maxillofacial reconstructive surgeries was conducted from January 2014 to June 2020. The categorical parameters involved age, gender, disease etiology, disease site, defect size, bone flap segments, and flap type. Apart from descriptive data reporting, categorical data were related by applying the Fisher-exact test, and a p-value below 5% was considered statistically significant (P < 0.05).ResultsThe main reasons for partial or non-adherence included unfitness, patient health condition, and other subjective reasons. Out of the total patient population, 118 patients who underwent mandibular reconstruction showed higher CAS compliance (83.9%) compared to the 18 midface reconstruction (72.2%) without any statistically significant difference (p = 0.361). Based on the size of the defect, a significantly higher CAS compliance (p = 0.031) was observed with a minor defect (80.6%) compared to the large-sized ones (74.1%). The bone flaps with two or more segments were significantly (p = 0.003) prone to observe a partial (15.4%) or complete (12.8%) discard of the planned CAS compared to the bone flaps with less than two segments. The malignant tumors showed the lowest CAS compliance when compared to other disorders without any significant difference (p = 0.1).ConclusionThe maxillofacial reconstructive surgical procedures offered optimal compliance to the initially planned CAS. However, large-sized defects and multiple bone flap segments demonstrated a higher risk of partial or complete abandonment of the CAS.

A Novel “Shark-Fin” Pyramidal Achilles Bone-Tendon Allograft Surgical Technique for Delayed Reconstruction of Triceps Tendon Rupture and Review of the Literature

Introduction: Triceps tendon injuries are rare and often caused by direct trauma to the arm. There are no clear guidelines on the management of these and typically partial tears are treated conservatively whilst full thickness tears are treated with primary surgical repair. We aim to review the literature on the methods for triceps repair and propose a novel surgical technique. Methods: A “Medline” and “Embase” literature search of titles and abstracts combining “triceps brachii muscle,” “reconstruct/ed” or “reconstruction” alongside “reconstructive surgical procedures,” and further cross referenced with “repair/s/ed.” Excluded those related to brachial plexus injuries or general elbow trauma and removing duplicate results. 32 English results within 10 years were relevant and reviewed. Results: A 50-year-old gentleman with a 4-month-old full thickness triceps tear was repaired with a novel surgical technique of using an Achilles bone-tendon allograft fashioned into a “shark-fin” pyramidal shape and secured to the proximal ulnar in a lock and key type construct. The tendon was secured to the triceps remnant using a Krackow stitch. Complete radiological and clinical recovery was made by 18 months postoperatively with return to full physical activity. The literature review concluded no consensus in the method of treatment for delayed triceps reconstruction. Conclusion: The use of the bone-tendon allograft specifically shaped to fit congruently into an olecranon osteotomy site allows for direct bone-to-bone healing has not previously been mentioned in the literature. Results have been encouraging and the technique described is easily reproducible. Keywords: Triceps rupture, delayed, reconstruction, achilles allograft, surgical technique, literature review.

3D Printing in Breast Reconstruction: From Bench to Bed

Surgical management of breast cancer often results in the absence of the breast. However, existing breast reconstruction methods may not meet the need for a replacement tissue. Tissue engineering with the use of emerging materials offers the promise of generating appropriate replacements. Three-dimensional (3D) printing technology has seen a significantly increased interest and application in medically-related fields in the recent years. This has been especially true in complex medical situations particularly when abnormal or complicated anatomical surgical considerations or precise reconstructive procedures are contemplated. In addition, 3D bio-printing which combines cells with bio-material scaffolds offers an exciting technology with significant applications in the field of tissue engineering. The purpose of this manuscript was to review a number of studies in which 3D printing technology has been used in breast reconstructive surgical procedures, and future directions and applications of 3D bio-printing.

A Novel Technique for the Reconstructive Formation of an Annular Hymen in Cases of Postpubertal Imperforate Hymen

Objectives: Imperforate hymen (IH) is a common genital tract anomaly in women which usually presents after puberty. However, surgical treatment is often considered controversial in religious or conservative communities for sociocultural reasons. This study therefore aimed to assess the efficacy of a novel reconstructive technique involving the preservation of the annular hymen. Methods: This prospective interventional study was performed between July 2013 and October 2019 at the minimally invasive surgery unit of a tertiary university hospital in Egypt. A total of 36 women presenting with primary amenorrhoea and haematocolpus were diagnosed with postpubertal IH. A circular hymenotomy was performed on each patient using a 10 mm laparoscopy trocar tip and sleeve to form a new annular hymen under general anaesthesia while preserving the annular hymen. The primary outcome measure was the persistence of hymenal patency and integrity at follow-up. The secondary outcome measure included post-operative patient satisfaction and pain relief. Results: The reported technique was feasible in all cases without intraoperative complications. Patency of the reconstructed annular hymen was confirmed at follow-up in all cases; moreover, no intraoperative complications were reported. There was a significant post-operative improvement in pain scores (P <0.001). Both the patients and their parents/guardians reported a high level of satisfaction with the technique. Conclusion: This novel technique for the correction of IH involving the reconstruction of an annular hymen was found to be a safe, minimally invasive and effective procedure. This technique should be considered a feasible alternative to a conventional hymenotomy as it allows for the resumption of normal hymenal anatomy without overtreatment. KEYWORDS Congenital Abnormalities; Imperforate Hymen; Hematocolpos; Amenorrhea; Colpotomy; Reconstructive Surgical Procedures; Treatment Outcome; Egypt.

P17: IMPROVING PLASTIC SURGERY OPERATION NOTE ACCESSABILITY AT A MAJOR TRAUMA CENTRE: A PROSPECTIVE COMPLETED AUDIT CYCLE

Introduction Quality operation note documentation is essential for ensuring continuity of care amongst the multi-disciplinary team. The Royal College of Surgeons has published clear and succinct guidelines which outline the necessity for timely, accurate and accessible operation note documentation. Our department uses a bespoke electronic operation note template which is stored within a departmental database. The aim of this study was to evaluate the effect of online operation note guidance on the accessibility of operative documentation. Method A prospective audit of operation note documentation was conducted during two one-month periods in May and November 2018. All reconstructive surgical procedures, both trauma and elective, were included. A bespoke online reminder system was introduced to our electronic platform to encourage operation note upload onto electronic medical records. Result 224 cases (127 elective, 98 consultant-led) were included in the initial audit and 239 cases (173 elective, 131 consultant-led) in the post-intervention audit. 56% of operation notes were accessible to nursing staff pre-intervention. Post-intervention 83% of operation notes were accessible to nursing staff (p&lt; 0.05). No significant correlation was found between operation note accessibility and the type of case (elective vs emergency, r= -0.179), grade of operating surgeon (consultant vs registrar, r=0.259) and the number of operating surgeons (r=0.208). Conclusion This study highlights the importance of operation note accessibility to every member of the multidisciplinary team. A pop-up based intervention significantly improved accessibility of operation notes within electronic medical records although performance remains significantly below the expected standard. Take-home message The use of bespoke, online platforms may limit access to operation notes. A simple, pop-up based intervention significantly improves upload rate to electronic medical records however accessibility remains significantly below the expected standard.

Placenta percreta after Strassman metroplasty of complete bicornuate uterus: a case report

Background A bicornuate uterus often results in infertility. While reconstructive procedures may facilitate pregnancy, spontaneous abortion or serious pregnancy complications may occur. We present a case of a bicornuate uterus with spontaneous conception after Strassman metroplasty; however, life-threatening complications during pregnancy occurred. Case presentation : A 38-year-old woman with a history of infertility presented for prenatal care at 6 weeks of gestation. She had conceived spontaneously after four failed in vitro fertilization and embryo transfer (IVF-ET) procedures, Strassman metroplasty for a complete bicornuate uterus, and two postoperative IVF-ET pregnancies that ended in embryo arrest. This pregnancy was uneventful until the patient presented with massive vaginal bleeding at 28 weeks of gestation and was diagnosed with placenta previa and placenta percreta. Bleeding was controlled after emergency Caesarean section and delivery of a healthy neonate. However, severe adhesions were noted as well as a rupture along the metroplasty scar. Two days later, on removal of the intrauterine gauze packing, severe hemorrhage resumed, and the uterus did not respond to oxytocin, hemabate, or carbetocin. Emergency hysterectomy was required. Conclusions Reconstructive surgical procedures for complete bicornuate uterus may allow patients to achieve spontaneous pregnancies. However, potential intrapartum complications include placenta implantation and postpartum hemorrhage, and the latter may be exacerbated as the uterus does not contract or respond to oxytocin or prostaglandin drugs. Patients should be counseled on the risks associated with pregnancy after Strassman metroplasty, and clinicians must be aware of potential severe complications.

Efficacy and Safety

Electrical stimulation of the hypoglossal nerve through implantable neuromodulation systems (UAS) has been demonstrated to be both safe and effective in the management of obstructive sleep apnea (OSA) in a subset of patients meeting specific clinical criteria. After decades of animal and human basic science research confirmed the feasibility and safety of UAS, multiple prospective studies, including the phase III multicenter Stimulation Therapy for Apnea Reduction (STAR) trial, demonstrated the efficacy of UAS in improving both polysomnographic (apnea–hypopnea index, oxygen desaturation index) and patient-reported (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Snoring Visual Analog Scale) outcome measures. Even with the widespread dissemination into routine clinical practice and commercial availability of the therapy across the United States and Europe, these studies also consistently report very low procedure-related or therapy-related serious adverse event rates. Recent comparison studies with upper airway reconstructive surgical procedures suggest that UAS provides treatment that is at least as effective but with reduced postoperative pain and risk, and with preservation of the upper airway anatomy.

A RARE VARIATION OF ACCESSORY FLEXOR CARPI ULNARIS MUSCLE: A CASE REPORT

Normally exor carpi ulnaris arises as two heads one from humerus and another from ulna. During the routine dissection of undergraduate medical students a rare variation of exor carpi ulnaris was found. A fully developed additional muscle belly was found on the exor compartment of the left forearm. The additional muscle belly was found medial to exor carpi ulnaris and it had a eshy part and a tendinous part. Fleshy part was coming from ulnar head of exor carpi ulnaris and the tendon was getting inserted to exor retinaculum. There was no separate nerve and blood supply to the accessory muscle bers. Variations in the forearm muscles are of utmost importance both anatomically as well as clinically and may be anticipated to avoid complications during reconstructive surgical procedures.