Search

Objective: To share our experience with nasal reconstruction and to give a standardized algorithm for nasal reconstruction. Study Design: Descriptive cross sectional. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2022. Material & Methods: Data was obtained from patient records after approval from IREB. Patients with multiple co-morbidities and small defects (<1.5cm) were excluded from this study. Defects were classified based on anatomic areas of radix, dorsum, sidewall, alar and lower third nasal defects. Cases were cross tabulated regarding site for the reconstructive options to generate the treatment algorithm. Results: A total of 51 cases were included in the study including 30 (58.8%) male patients. Mean age of patients was 48.12+21.89SD. Skin malignancies were the most common (n=35, 68.6%). Nasal ala was the most common site reconstructed in our study (25.5%) followed by nasal dorsum and sidewalls. Medium size (41.2%) was the most common. In 64.8% (n=33) cases, forehead based flaps were used to reconstruct the nasal defects (Table-I). In 5.9% cases we observed flap congestion. In 19 (37.25%) cases, patients presented with additional soft tissue defects which needed reconstruction (Table-II). Reconstructive options are presented as an algorithm based on the defect site (Figure-1). Conclusion: In this study we shared our experience with the readers regarding reconstruction of the nasal detects. We have formulated an algorithm for reconstruction of these defects that will simplify reconstruction in such cases. [ABSTRACT FROM AUTHOR]

This occurred despite the fact that the patients in the prehospital transfusion group had a higher admission mean hemoglobin (Hb) concentration than the patients in the control arm (133 g/L vs. 118 g/L, respectively; I p i < 0.001), a small and nearly identical fraction of patients in both groups had an admission INR >1.5 (described above), and the patients in both groups had identical mean admission systolic blood pressures (114 mmHg; I p i = 0.74). It is clear from these three trials that some trauma patients derive lifesaving benefit from prehospital transfusions, and the design of future studies and sub-analyses should be further refined to more clearly elucidate those patients who might benefit. Keywords: COMBAT; emergency medical service; mortality; outcome; PAMPer; prehospital transfusion; randomized trial; red blood cell; RePHILL; trauma EN COMBAT emergency medical service mortality outcome PAMPer prehospital transfusion randomized trial red blood cell RePHILL trauma 1671 1679 9 08/09/22 20220801 NES 220801 Abbreviations BP blood pressure ED emergency department GCS Glasgow coma scale LTOWB low titer group O whole blood RBC red blood cell RCT randomized controlled trial For with much wisdom comes much sorrow, and as knowledge grows, grief increases. Similarly, recognizing patients with unsurvivable injuries (i.e., injuries leading to nonpreventable death) and excluding them from future studies will also help to better establish those patients who might benefit from prehospital transfusions.31-33 These should be major areas of future research to optimize patient care and to help steward the inventory of precious blood products. [Extracted from the article]

Objective: We aim to look at the epidemiology of lower limb trauma and study the post-operative functional outcome. Study Design: Descriptive study Sett ing: Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar Duration: six years Material and Methods: After approval from the ethical board, data was collected from hospital records. Data regarding patient demographics, site, anatomic location of injury, and type of reconstructive procedure done was collected. Complications including partial (significant or insignificant) or complete necrosis was documented. Toronto extremity Salvage (TESS) score was calculated. Results: A total of 73 patients underwent lower limb reconstruction with mean age of 28.7+12.5 SD. Road traffic accidents (RTA) were the main cause of lower limb trauma (45.2%). There were 54.8% defects with associated fractures, most commonly tibia. The mean duration of presentation for reconstruction was 5.3 week +10.23SD. Total of 81 flaps were performed (68 pedicled and 13 free micro-vascular flaps). 35-patients required bony stabilization. Infection (8.2%) was the most common complication. Partial Flap necrosis was observed in 4(5.5%) cases, out of which 3(4.1%) were significant partial necrosis. Mean Toronto Extremity Salvage Score (TESS) was 84.8+13.6 SD. Discussion: Mostly younger male population are involved with lower limb trauma. Most patients had delayed presentation due to under developed infra-structure in the tribal areas and issues with timely referral from peripheral health care facilities. Most of the small and medium defects can be closed with local flaps. However large defects with bone involvement required free microvascular flaps. Post-operative outcome was good using TESS score. Conclusion: Robust referral system and single stage orthoplastic procedures should be adopted. Multi-center studies need to be conducted and liaison with orthopedic department is paramount to improve outcomes. [ABSTRACT FROM AUTHOR]

Whole body contrast-enhanced multidetector CT (WB-CE MDCT) is integral to the assessment of the severely injured patient with stable haemodynamic parameters or in those who respond to resuscitation with blood products. WB-CE MDCT is able to identify the number and severity of injuries sustained by the patient and enable time critical intervention. In this narrative review article we discuss how communication within the trauma team, including the radiologists and appropriate clinicians is crucial in optimizing the effectiveness of WB-CE MDCT. We review the time critical imaging findings and their clinical relevance, which should be included in a succinct CT primary survey report. We also discuss the process through which the effectiveness of the trauma report may be maximised and how non technical factors including teamwork may be optimised to facilitate decision making in this high pressure environment. [ABSTRACT FROM AUTHOR]

The recent coronavirus disease (COVID-19) pandemic has increased doctors' stresses at work and at home, putting them at increased risk of burnout. Considering this, we recently conducted the British Orthopaedic Association (BOA) Burnout and Wellbeing Survey which showed that, from 1298 respondents (approximately 25% of the membership of the BOA), 40% reported burnout and a further 50% were just below the threshold. The burnout rates were found to be higher in Black, Asian and minority ethnic (BAME), female and LGBTQ+ groups (45.6%) compared to white, heterosexual males (33.6% - p < 0.001) and also higher in trainees (49.1%) and associate specialists (52.1%) compared to consultants (35.7% - p < 0.001). We discuss what can be learned from the experience of the UK Armed Forces in their programme for stress management, their mental resilience training and their campaign to destigmatize mental wellbeing, that may mitigate burnout in our profession. We also put forward the case for appropriate resources to be allocated to tackling burnout in orthopaedic doctors and introduce the BOA's Wellbeing Initiative. [ABSTRACT FROM AUTHOR]

Introduction: Stabbings are an increasing international problem and the UK is not exempt. Although the incidence and costs of negative laparotomy are well known, and laparoscopy has been available for over 100 years, it is only in the last three decades that has seen its effective utilization in trauma both as a diagnostic and therapeutic modality. Methods: A retrospective two-year study of all patients undergoing laparoscopy for suspicion of diaphragmatic injury or breach of the peritoneum who were haemodynamically stable from non-ballistic penetrating torso trauma at St Mary's Hospital (Imperial Healthcare Trust). Results: Three groups of patients were identified: diagnostic laparoscopy without injury (n = 31), laparoscopy with injury ± laparoscopic treatment (n = 41) and diagnostic laparoscopy converted to laparotomy (n = 10). The patients who had laparoscopic intervention had a shorter hospital stay (2 vs. 5 days, p = 0.004), decreased intensive treatment unit admission (p = 0.007) and decreased intensive treatment unit stay (p = 0.007) compared to those who had conversion to laparotomy. Conclusion: Trauma laparoscopy is a useful modality in managing selected trauma patient with suspected intra-abdominal injuries and can avoid unnecessary laparotomy. It is associated with a shorter hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Early cervical spine immobilisation has long been considered the standard of care in the management of trauma patients with suspected spinal cord injury. There has been conflicting evidence regarding its benefits and risks. This article reviews the current literature and whether the continued use of routine cervical spine immobilisation is still appropriate in modern trauma care. Method: A literature search was conducted using the Medline PubMed, Google Scholar and Cochrane Library online databases. The searches were limited to full text, English language studies conducted on adults in the last 20 years (July 1997 to July 2017). Results: The entrenchment of cervical spine immobilisation in trauma management is multifactorial. In the pre-hospital setting, immobilisation is recommended whilst awaiting full assessment. Fear of missed diagnoses of spinal injuries encourages defensive medicine and over-immobilisation. Effective cervical spine immobilisation is appropriate in certain cases and reduces the risk of further spinal cord injury. However, research has shown that we are over-immobilising, and in penetrating trauma, cervical spine immobilisation increases the risk of mortality. Conclusions: The practice of routine cervical spine immobilisation for trauma patients is outdated, ineffective and results in iatrogenic injury. Routine cervical spine immobilisation is not backed up by robust evidence. It has been clearly shown that in cases of penetrating spinal injuries, cervical spine immobilisation is not only ineffective but is also linked to an increased risk of mortality. Special considerations must also be taken in patients who have pre-existing spinal conditions, impending airway compromise, or at risk of aspiration and those with head injuries or suspected traumatic brain injuries. A selective approach to cervical spine immobilisation is recommended and should be reserved for cases deemed high risk rather than a standard rule for all trauma patients. [ABSTRACT FROM AUTHOR]

Objectives: To determine the reliability and versatility of forehead flap in terms of frequency of complications and uses. Study design: Cross-sectional observational study Settings: This study was performed from January, 2014 to December, 2018 in the departments of Plastic and Burns Hayatabad Medical Complex, Peshawar and Khyber Teaching Hospital, Peshawar. Material and Methods: After approval from the ethical committee, the data was collected of all patients in whom forehead flap was performed, was collected from hospital's record. The data were analyzed and organized to assess the demographics, etiologies of defects covered, type of flap used and frequency of complications. The results were projected in the form of tables and figures. Results: A total of 26 patients, including 17 (65.4%) male and 9 (34.6%) female patients with age ranging from 10 years to 70 years (mean 47+1.89) met the inclusion criteria. Nose was the most common site of defects with the main etiology of surgical excision of malignancies. The paramedian variant of forehead flap was performed in 69.2% which was used as island in 15.4% cases. We observed insignificant partial necrosis of the forehead flap in 3.8% case. In 76.9% case the donor forehead defect was closed primarily. Conclusion: The forehead flap is a very reliable flap for nasal and upper facial defects with good aesthetic results and low complication rates. [ABSTRACT FROM AUTHOR]

Objectives: To determine the reliability and versatility of Superficial Sural Artery Flap (SSAF) for lower limb reconstruction in terms of flap survival and frequency of complications. Material and Method: This cross-sectional study was conducted in the department of Plastic and Burns Surgery, Khyber Teaching Hospital Peshawar from June 2014 to October 2016. All patients with leg defects, reconstructed with SSAF were included in the study. The data was acquired from the Hospital's record and analyzed with statistical package for social sciences (SPSS) to determine the frequency of different type and design of SSAF used and its complications of venous congestions and flap necrosis. Results: During the study duration, 16 male patients were included with age ranging from 12 years to 60 years with a mean of 36.18 years +SD. Road traffic accident was the most common etiology of the soft tissue defects (68.8%). Six (37.5%) patients had distal leg defects as the most common site of soft tissue loss. Reverse Superficial Sural Artery Flap (RSSAF) was performed in 10 (62.5%) followed by Proximally Based Superficial Sural Artery Flap (PSSAF) in 6 (37.5%). Flap congestion was observed in 5 (31.2%) patients. We did not observe any complete flap loss. In one case (6.2%) case, partial significant flap necrosis was noted. Conclusions: Superficial Sural Artery Flap is reliable source of reconstruction which can be used for the soft tissue defects of distal thigh, knee, leg, heel and proximal foot due to its versatile blood supply. [ABSTRACT FROM AUTHOR]

The current method of extricating a driver after a collision in motorsport remains controversial. The current setup and deployment of both vehicles and personnel are outdated and in certain circumstances potentially dangerous to drivers. This analysis, based on current literature and the specialist expertise of the authors, endeavours to address the issues and make evidence-based recommendations. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the demographics, mechanism, nature, anatomical distribution, management and complications in trauma patients presenting to the plastic surgery unit. Study Design: Descriptive cross-sectional study. Setting: This study was conducted in the Plastic and Reconstructive Surgery Unit, Hayatabad Medical Complex, Peshawar, from 1st January 2009 to 30th April 2012. Materials and Methods: All trauma patients referred from emergency department and other departments irrespective of age and gender were enrolled in the study, excluding acute burns and trauma sequelae patients. The details were obtained from the data sheets of the patients. All the data were analysed and projected in the form of tables and figures. Results: A total of 1034 patients including 855 (82.7%) males and 179 (17.3%) females presented with plastic surgical trauma, with age ranging from 1 to 86 years, with a mean age of 20.84 ± 15.469 SD. The upper limb was affected in 492 (47.6%) patients, followed by head and neck in 273 (26.4%) cases. Road traffic accidents (RTAs) were the main cause of trauma, affecting 340 (32.9%) patients. Wound excision and closure was performed in 473 (45.7%) patients, followed by skin grafting and flap coverage in 232 (22.4%) and 132 (13.2%) patients, respectively. Postoperative complications were observed in 45 (4.35%) patients. Conclusion: Males in their young age mainly presented with plastic surgical trauma with RTA as the main mechanism and laceration as the most common type of these injuries. The upper limb was the most commonly affected region. The frequency of different types of surgical procedures and postoperative complications observed are comparable with international literature except for the microvascular surgery which is not performed in our centre. Regular audit of the plastic surgical trauma should be conducted in all plastic surgical units to both improve trauma care and reaffirm the role of Plastic Surgery in the new age trauma. [ABSTRACT FROM AUTHOR]

Injuries to the duodenum pose a diagnostic and therapeutic challenge to the surgeon. Due to the intra- and extra-peritoneal location of the duodenum, the presentation can be overt or occult, and delay in diagnosis is associated with an increased mortality rate. A range of interventions have been described and this article reviews the relevant literature, highlights the salient points and suggests a treatment algorithm. [ABSTRACT FROM PUBLISHER]

Background: Traumatic injury is the third leading cause of death overall. To optimize the outcomes in these patients, hospitals employ whole-body computed tomography (WBCT) imaging due to the high diagnostic yield and potential to identify missed injuries. However, this delays time-critical interventions. Currently, there is an absence of any high-level evidence to support or refute either view. We present a meta-analysis of the available literature to elucidate the efficacy of WBCT in improving the outcomes of trauma, specifically the mortality rate.Methods: A systematic review of studies comparing WBCT and selective CT imaging in secondary survey was conducted, using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. The articles were evaluated for intervention using WBCT to reduce mortality rate, followed by subgroup analysis for other secondary measures, using Review Manager 5.3 software.Results: Eleven studies of 32,207 patients were included. There were lower overall (OR=0.79; 95% CI 0.74,0.83, p<0.05) and 24h mortality rates (OR=0.72, 95% CI 0.66,0.79, p<0.05) in the WBCT cohort. Additionally, patients in the WBCT arm spent less time in the emergency room (MD=-14.81; 95% CI -17.02, -12.60, p<0.00001) and needing ventilation (MD=-2.01; 95% CI -2.41, -1.62, p<0.05) despite a higher baseline injury severity score.Conclusion: The analysis shows that WBCT is associated with better outcomes, including a lower overall and 24h mortality rate, however the included studies are mostly observational and show considerable heterogeneity. Further work is required to make definitive clinical recommendations for a tailored algorithm in managing trauma patients. [ABSTRACT FROM AUTHOR]