Flexor Tendon Injuries in the Hand: A UK Survey of Repair Techniques and Suture Materials—Are We Following the Evidence?

Introduction. Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in the hand are dependent on a sound surgical repair allowing early active mobilisation. Materials and Methods. We reviewed the literature regarding the choice of suture material and repair technique. We then carried out a nationwide postal survey of plastic surgery hand units to assess the level of compliance with the evidence. Results. Fifty-four units were surveyed. The response rate was 72%, with the most popular core suture being Prolene (64%) and the most popular technique being the Kessler repair (36%). Discussion. Current evidence advocates a multistrand repair using Ethibond. We found that the majority of units are not following the evidence. We suggest the use of evidence-based departmental guidelines to improve the practice and outcomes following these common injuries.

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Defects at this site will often require flap cover. Free flap is ideal for these defects and gives good results but with its own limitations. The reverse sural artery flap (RSAF) and distal peroneus brevis flap (DPBF) have gained popularity for lower third leg defects among surgeons. We did a retrospective study on 64 patients admitted between 2011 and 2013 with posttraumatic moderate size defects of lower one-third leg who underwent RSAFs and DPBFs. These patients were followed up in the immediate and late postoperative period for complications and outcome assessment. The average surface area covered by DPBF was 27 cm2 and by RSAF was 38 cm2. Both flaps gave a good functional outcome. DPBF has better aesthetic appearance at donor site and recipient site, with the advantages of ease of surgery, speedy recovery, less hospital stay, and no donor site morbidity; DPBFs appear to be a preferred choice for moderate size lower third leg defects. RSAFs should be chosen over DPBFs for defects in medial malleolus and larger size defects.

Simultaneous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients

The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation.

Orofacial Clefts: A Clinical Community Study in a Developing Country

Aim. The study aimed at finding the types of orofacial clefts, reasons for delay in the repair of the deformity and medium through which patients and/or their relatives heard about the outreach program. Methods. This study was from 2009 to 2011 at two different study sites. The team visited various media houses and health facilities at each study site to disseminate information concerning the cleft outreach program. Patients and/or their parents who visited the hospitals were interviewed using a questionnaire designed for the study to retrieve needed information for the study. Patients were then examined and booked for cleft repair by specialists in the team. Results. A total of 61 patients were recorded from both study sites, with ages ranging from 3/12 to 54 years old, with a mean age of 6.7±2.7 (SD) years; while, male : female ratio was 1.05 : 0.5. Cleft lip only (52.5%, n=32) was the highest type of orofacial cleft recorded in the study. In terms of occurrence, complete cleft (63.9%, n=39) was majority; while, position-wise, unilateral cleft right (32.8%, n=20) was the highest. A significant (P=0.017) association between males and unilateral right cleft lips was identified. Lack of finance (47.5%, n=29) was the main reason for delaying in deformity repair. Also, information from physician (41.0%, n=25) was the major medium for information dissemination. Conclusion. Unilateral cleft lip constitutes most of the orofacial clefts in this study, with lack of finance being the commonest reason why patients delay in the repair of their deformity.

The “Power” Brow Lift: Efficient Correction of the Paralyzed Brow

Purpose. To describe a novel approach to brow ptosis correction and evaluate its long-term efficacy in patients with facial-paralysis-associated brow ptosis. Methods. Twenty-two patients aged from 50 to 90 years underwent “power” brow lifting, involving 3 intrabrow stab incisions and suture suspension of the brow to the frontal calvarium via titanium miniplate. Long-term results of the operation were assessed retrospectively. Pre- and postoperative photographs were measured with FACE-gram software to evaluate efficacy of the procedure. Results. Seventeen patients who underwent “power” brow lift were available for postoperative evaluation. Among them, follow-up length ranged from 12 to 448 days. The average post-operative change in brow height was 5.7 mm, which was statistically significant (). There were no complications. Conclusions. The “power” brow procedure can help to restore upper facial symmetry and visual fields and improve periocular hygiene. The operation is easily performed in an office setting, under local anesthesia, and appears to provide reliable long-term results. The time required to perform the procedure is far less than that required for a standard direct brow lift; there is no risk of postoperative forehead hypesthesia, and there is no superciliary scar.

Evaluation of Facial Esthetics in Rehabilitated Adults with Complete Unilateral Cleft Lip and Palate: A Comparison between Professionals with and without Experience in Oral Cleft Rehabilitation

Objectives. The aim of this study was to evaluate the facial esthetics of White-Brazilian adults with complete unilateral cleft lip and palate (UCLP) rehabilitated at a single center. Design. 30 patients (13 females; 17 males; mean age of 24.0 years), rehabilitated at a single center, were photographed and evaluated by 25 examiners, 5 orthodontists, and 5 plastic surgeons dealing with oral clefts, 5 orthodontists and 5 plastic surgeons with no experience in the cleft treatment, and 5 laymen. Their facial profiles were classified into esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Results. Orthodontists dealing with oral clefts classified the majority of the sample as esthetically pleasant. Plastic surgeons dealing with oral cleft, orthodontists, and plastic surgeons without experience with oral clefts classified most of the sample as esthetically acceptable. Laymen evaluation also considered the majority of the sample as esthetically acceptable. Conclusions. The facial profiles of rehabilitated adults with UCLP were classified mostly as esthetically acceptable, with variations among the categories of examiners. The examiners dealing with oral clefts gave higher scores to the facial esthetics when compared to professionals without experience in oral clefts and laypersons, probably due to their knowledge of the limitations involved in the rehabilitation process.

Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers

Background. With greater experience in microsurgical reconstruction, free tissue transfer has become common and reliable. However, total flap necrosis after microsurgical reconstruction is sometimes seen in patients who have undergone radical ablation of head and neck malignancies. We investigated factors predicting free flap loss in head and neck reconstruction. Methods. We reviewed the records of 111 free flap reconstructions carried out among 107 patients with head and neck cancer who required radical resection and microsurgical reconstruction in our unit from 2004 through 2010. Among these patients, 6 showed total flap necrosis postoperatively. We investigated the associations between primary or recurrent tumor, type of flaps, chemotherapy, and radiotherapy and flap loss. Results. Five of 20 (25.0%) patients who underwent radiotherapy developed flap necrosis: among the 91 patient who did not undergo radiotherapy, only one (1.1%) developed. Preoperative radiotherapy was statistically identified as the most important risk factor for postoperative flap failure. Conclusions. Patients receiving radiation treatment are more likely to develop total flap failure when they undergo reconstructive surgery with free flaps after tumor ablation, because the combination of endarteritis and chronic ischemia caused by radiation damaged endothelial membrane in the recipient vessels, consequently, thrombosis tends to develop.

An Audit of Surgical Management of Pressure Sores in a Resource Constrained Hospital in Kenya

Objective. To determine the surgical management of pressure sores at the National Spinal Injury Hospital and the outcome. Design. This was a four-year prospective study from June 2008 to June 2012. Setting. The study was carried out at the National Spinal Injury Hospital, Nairobi, Kenya. Subjects. Patients with pressure sores operated on during the defined period of study. Results. A total of 46 patients with 58 pressure sores were operated on during the defined period of study. The male : female ratio was 10.5 : 1. The mean age was 36.5 years. Trochanteric sores accounted for 60 percent of the pressure sores operated on with the V-Y tensor fascia lata, the commonest surgical procedure, accounting for 37 percent of the procedures performed. At one year of followup 90 percent of the surgeries done were successful with no ulcer recurrence noted. Conclusion. Surgical management of pressure sores even in resource constrained environment would result in faster rehabilitation and early patient discharge. The recurrence of the pressure sores could be greatly reduced by involving patients relatives in the rehabilitation and home-based care.

Managing Acute Wounds with Negative Pressure System in a Developing Country

Introduction. The negative pressure system has been found to be a valuable addition to the various procedures of wound management and has been widely accepted to be safe and effective in promoting wound healing. Aim. The study seeks to find out the outcome of the use of the VAC device in the treatment of patients with acute wounds. Materials and Methods. Between January 2009 and December 2011, a consecutive nonrandomized study was conducted among 48 patients who presented with acute wounds at the Komfo Anokye Teaching Hospital. Patients were made to undergo negative pressure wound therapy using the VAC device. Results. Forty-eight patients with various degrees of acute wounds were treated, of which 43 (89.6%) were females and 5 (10.4%) were males. Ages of patients ranged from 19 to 78 years. Satisfaction with rate of wound healing revealed that 86.7% and 8.9% had excellent and good healing, respectively, while 4.4% said theirs was satisfactory. Therapy was discontinued in three (6.3%) patients who developed some complications. Conclusion. There was reduction in the hospitalization by patients thereby reducing costs. Also, quality of life of persons who had undergone the therapy with the VAC device had improved. Even though a few device-related complications were observed, patient satisfaction was high.

Orofacial Clefts: A Worldwide Review of the Problem

Orofacial cleft is one of the commonest congenital abnormalities which impacts negatively on the life of the individual and to a large extent affects the family. Caused by the interaction of environmental and genetic factors, this abnormality brings about decreased quality of life. Management of this abnormality entails a team involving a cleft surgeon, speech therapist, dentist, orthodontists, and so forth. This study involves the review of the various literatures on orofacial clefts, discussing the problems on the genetic basis, associated syndromes, and their management. Counseling of prospective mothers should be promoted to ensure that the abnormality is prevented at the early stages. Education on orofacial clefts should be promoted to create awareness on its preventive measures. Much attention must be geared towards cleft genetics studies to identify potential risk factors which might be predisposing individuals to the anomaly.