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1. Vacuum-assisted closure – a management option for the burns patient with exposed bone

Author

N. Nugent, D. Lannon, and M. O’Donnell.

Subjects
Adult, Male, Surgical Sponges, Suction (medicine), medicine.medical_specialty, Vacuum, medicine.medical_treatment, Suction, Critical Care and Intensive Care Medicine, medicine, Humans, Aged, Wound Healing, Debridement, business.industry, Soft tissue, Granulation tissue, General Medicine, Middle Aged, Surgery, Plastic surgery, medicine.anatomical_structure, Emergency Medicine, Skin grafting, Burns, Wound healing, business, Leg Injuries
Abstract

Exposed bone, secondary to debridement of severe burns to the lower limb, presents a challenge to the plastic surgeon. Techniques to provide soft tissue cover, such as local tissue advancement are limited, due to the severe thermal damage to the tissue surrounding the wound. Free tissue transfer may be relatively contraindicated by the patient’s systemic problems. Until such soft tissue cover can be provided, split thickness skin grafting will not be successful. Limb amputation is sometimes the only option available to this group of patients. The advent of vacuum-assisted closure (VAC) devices has changed many wound management practices. This technique, first described by Argenta and Morykwas [1,2], involves the insertion of a foam sponge into the wound cavity and achieving an airtight seal with the adhesive covering. Subatmospheric pressure is then applied. Wound healing is thought to be promoted by the removal of interstitial oedema, the increase in local blood flow and stimulation of granulation tissue formation secondary to negative pressure application [1–3]. Tissue bacterial counts have also been shown to be reduced [1,2]. We present a series of three patients, all of whom had severe lower limb burns with exposed bone following debridement, in whom vacuum-assisted closure dressings were applied and helped achieve soft tissue cover. Subsequent split thickness skin grafting was possible for wound closure, and limb salvage was achieved in each case.

Published
2005
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2. National scientific medical meeting 1995 abstracts

Author

S. Norris, C. Collins, J. Hegarty, C. O’Farrelly, J. Carton, L. Madrigal, D. P. O’Donoghue, H. Holloway, J. F. Fielding, W. Mullins, S. W. Hone, M. Donnelly, F. Powell, A. W. Blayney, E. A. Cahill, S. F. Daly, M. J. Turner, P. A. Sullivan, M. McLoughlin, M. M. Skelly, H. E. Mulcahy, T. Connell, C. Duggan, M. J. Duffy, A. Troy, K. Sheahan, A. Whelan, C. M. Herra, C. T. Keane, H. Johnson, B. Lee, E. Doherty, T. McDonnell, D. Mulherin, O. FitzGerald, B. Bresnihan, H. M. Hassett, A. Boyce, V. Greig, C. O’Herlihy, P. P. A. Smyth, E. F. Roche, I. McCormack, E. Tempany, M. J. Cullen, D. F. Smith, Y. McBrinn, B. Murray, R. Freaney, D. Keating, M. J. McKenna, J. A. O’Hare, H. Alam, Q. Raza, M. Geoghegan, S. Killalea, M. Hall, J. Feely, L. Kyne, B. O’Hara, M. Cullen, I. M. Rea, J. P. Donnelly, R. W. Stout, P. Lacey, M. J. Donnelly, J. McGrath, T. P. Hennessy, C. V. I. Timon, D. Hyde, H. X. Xia, M. Buckley, C. O’Morain, S. Keating, H. Xia, J. P. McGrath, R. C. Stuart, P. Lawlor, P. J. Byrne, T. N. Walsh, T. P. J. Hennessy, M. Duffy, M. Tubridy, J. Redmond, K. Monahan, R. P. Murphy, D. R. Headon, T. O’Gorman, F. M. O’Reilly, C. Darby, G. M. Murphy, A. Murphy, M. Codd, P. Dervan, D. Lawlor, S. O. Loughlin, N. Flanagan, R. Watson, L. Barnes, C. Kilgallen, E. Sweeney, A. Mynes, D. Mooney, I. Donoghue, O. Browne, J. A. Kirrane, D. McKenna, M. Young, E. O’Toole, S. O’Briain, U. Srinivasan, C. Feighery, N. Leonard, E. Jones, M. A. Moloney, D. G. Weir, M. Lawler, A. O’Neill, H. Gowing, D. Pamphilon, S. R. McCann, G. O’Toole, A. Orren, C. M. Seifer, D. C. Crowley, G. J. Sheehan, T. Deignan, J. Kelly, V. J. Tormey, J. Faul, C. Leonard, C. M. Burke, L. W. Poulter, S. Lynch, G. McEntee, O. Traynor, E. Barry, P. Costello, A. Keavney, R. Willoughby, C. O’Donnell, M. Cahill, A. Earley, P. Eustace, R. Osborne, C. Saidlear, B. Holmes, A. Early, A. P. Moran, A. Neisser, R. J. Polt, H. Bernheimer, M. Kainz, B. Schwerer, L. Gallagher, R. Firth, N. Kennedy, E. McGilloway, N. Tubridy, K. Shields, W. K. Cullen, M. J. Rowan, A. R. Moore, M. Rowan, D. Coakley, B. Lawlor, G. Swanwick, R. Al-Naeemi, R. Murphy, N. M. Codd, M. Goggins, N. P. Kennedy, B. L. Mallon, H. Mulcahy, M. Skelly, D. O. Donoghue, D. McCarthy, A. Saunders, D. J. Veale, J. J. F. Belch, D. Breathnach, E. Murphy, G. Kernohan, K. Gibson, A. G. Wilson, G. W. Duff, N. de Vries, L. B. A. van de Putte, J. Donoghue, F. O’Kelly, Z. Johnson, T. Maher, A. Moran, C. Keane, D. O’Neill, N. Horgan, J. M. Barragry, D. M. Campbell, M. Behan, P. R. O’Connell, V. S. Donnelly, D. Crowley, M. Geary, P. Boylan, M. Fanagan, K. Hickey, T. Teoh, M. Doyle, R. Harrison, D. Lyons, Y. Shenouda, M. Coughlan, P. McKenna, P. Lenehan, M. Foley, P. Kelehan, P. Ravichandran, M. Kelly, A. Conroy, C. Fitzpatrick, D. Egan, C. L. Regan, B. V. McAdam, P. McParland, G. A. FitzGerald, D. J. Fitzgerald, S. C. Sharma, K. Foran, C. Barry-Kinsella, R. F. Harrison, F. J. Gillespie, P. O’Mahony, M. Boyle, M. J. White, F. Donohoe, Y. Birrane, M. Naughton, R. B. Fitzsimons, M. Piracha, S. McConkey, E. Griffin, E. Hayes, T. Clarke, N. Parfrey, K. Butler, A. J. Malone, P. J. Kearney, P. F. Duggan, A. Lane, R. Keville, M. Turner, S. Barry, D. Sloan, S. Gallagher, M. Darby, P. Galligan, J. Stack, N. Walsh, M. O’Sullivan, M. Fitzgerald, D. Meagher, S. Browne, C. Larkin, P. Casey, E. O’Callaghan, S. Rooney, E. Walsh, M. Morris, T. Burke, M. Roe, C. Maher, M. Wrigley, M. Gill, M. Burgess, E. Corcoran, D. Walsh, B. Gilmer, C. B. Hayes, L. Thornton, J. Fogarty, R. Lyons, M. O’Connor, V. Delaney, K. Buckley, D. Lillis, V. Delany, C. Hayes, P. Dack, D. Igoe, H. J. O’Neill, P. Kelly, D. McKeown, L. Clancy, G. Varghese, S. Hennessy, J. J. Gilmartin, K. Birthistle, D. Carrington, H. Maguire, P. Atkinson, C. Foley-Nolan, M. Lynch, B. Cryan, D. Whyte, C. Conlon, V. Kucinskas, U. Usinskiene, I. Sakalyte, E. Dawson, K. Molloy, N. Goulden, J. Doyle, E. Lawlor, M. G. Harrington, N. El-Nageh, M. -L. Nolan, J. O’Riordan, G. Judge, G. Crotty, T. Finch, M. Borton, T. Barnes, O. Gilligan, G. Lee, R. Limmer, M. Madden, C. Bergin, A. O’Leary, F. Mulcahy, F. Wallis, M. Glennon, M. Cormican, U. NiRiain, M. Heiginbothom, F. Gannon, T. Smith, C. O’Sullivan, R. Hone, D. A. Caugant, C. A. P. Fijen, E. J. Van Schalkwyk, G. J. Coetzee, U. Ni Riain, M. G. Cormican, L. Park, J. Flynn, V. Regazzoli, M. Hayes, G. Nicholson, P. Higgins, N. Flynn, G. Corbett-Feeney, D. J. Conway, N. J. O’Higgins, S. Rajendiran, J. Byrne, E. Kilfeather, P. Dingle, M. Hunter, S. K. Al-Ghazal, P. Stanley, J. Palmer, A. Hong, P. Saxby, D. Sheehan, I. Regan, J. O’Mullane, M. Ni Chaoimh, M. Leahy, J. J. Heffron, M. Lehane, C. Keohane, N. O’Leary, M. Sheehan, E. Renny-Walsh, M. J. Whelton, C. T. Doyle, J. Webster, N. Benjamin, S. FitzGerald, J. S. Chadha, M. G. FitzGerald, G. R. FitzGerald, L. Hemeryck, P. McGettigan, J. Golden, N. Arthur, S. Y. Wen, P. Deegan, T. Cooke, G. I. Adebayo, P. Gaffney, M. Sinnot, D. O’Riordan, T. Hayes, C. M. O’Connor, M. X. FitzGerald, C. Costello, G. Finlay, J. Hayes, C. O’Connor, K. McMahon, S. Hone, J. Robertson, R. Coakley, S. O’Neill, M. Walsh, J. McCarthy, D. Lannon, A. E. Wood, R. Sharkey, E. Mulloy, M. Long, I. Kilgallen, V. Tormey, S. Horne, T. Feeney, Ó. Ó Muiré, M. J. Griffin, D. Hughes, A. Knaggs, D. Magee, C. McCrory, B. March, D. Phelan, M. White, J. Fabry, D. Buggy, C. Cooney, E. Aziz, D. O’Keefe, A. J. McShane, J. Boylan, E. Tobin, C. Motherway, F. Colreavy, N. Denish, R. Dwyer, A. Bergin, K. O’Brien, R. MacSullivan, K. D. Carson, W. P. Blunnie, D. C. Moriarty, B. Kinirons, B. Lyons, N. Cregg, W. Casey, K. P. Moore, S. A. Colbert, C. Ecoffey, D. O’Gorman, J. Fitzgerald, P. Diamond, M. B. Codd, D. D. Sugrue, J. Kellett, M. Tighe, C. J. McKenna, J. Galvin, H. A. McCann, A. Scallon, A. Fraser, M. Norton, G. Tomkin, I. Graham, A. Byrne, M. Maher, N. Moran, D. Fitzgerald, D. O’Callaghan, D. Coyle, A. G. Nugent, C. McGurk, G. D. Johnston, A. Nugent, B. Silke, N. Murphy, L. Jennings, D. Pratico, C. Doyle, T. Hennessy, H. McCann, D. Sugrue, S. Donnelly, A. Hennessy, C. Hartigan, D. MacDonald, S. Blake, D. McDonald, D. Dominque, S. R. McMechan, G. MacKenzie, J. Allen, G. T. Wright, G. J. Dempsey, M. Crawley, J. Anderson, A. A. J. Adgey, M. T. Harbinson, N. P. S. Campbell, C. M. Wilson, P. K. Ellis, E. M. McIlrath, A. McShane, T. V. Keaveny, K. Rabenstein, F. Scheller, D. Pfeiffer, C. Urban, I. Moser, G. Jobst, A. Manz, S. Verpoorte, F. Dempsey, D. Diamond, M. Smyth, E. Dempsey, V. Hamilton, J. Twomey, R. Crowley, L. Fenelon, F. Walsh, J. McCann, P. McDonagh, E. McGovern, D. Luke, K. Crowley, D. Mannion, D. Murphy, K. Clarkson, E. Carton, I. Leonard, D. O’Toole, M. Staunton, M. Griffin, D. Owens, P. Collins, A. Johnson, G. H. Tomkin, N. A. Herity, J. D. Allen, R. O’Moore, G. M. Crotty, M. DeArce, K. Nikookam, P. Keenan, D. Cregan, N. O’Meara, S. Forman, D. A. Cusack, and B. Farrell

Subjects
medicine.medical_specialty, business.industry, Family medicine, medicine, MEDLINE, General Medicine, business
Published
1995
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3. Video-assisted thoracic surgery (VATS) for spontaneous pneumothorax

Author

S. McKenna, D. Lannon, A. E. Wood, and J. McCarthy

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Video Recording, Postoperative Complications, Recurrence, medicine, Humans, Hospital Mortality, Thoracotomy, Aged, Aged, 80 and over, Endoscopes, business.industry, Pneumothorax, General Medicine, Middle Aged, Thoracoscopes, medicine.disease, Surgery, Survival Rate, Chest tube, Cardiothoracic surgery, Anesthesia, Video assisted thoracic surgery, Bilateral pneumothorax, Persistent air leak, Female, business, Pleurectomy
Abstract

Video-assisted thoracic surgery (VATS) involves using a thoracoscope with a camera chip attached to a video monitor which allows certain thoracic procedures to be performed with limited incisions. Using VATS, 170 procedures have been performed on 158 patients including 42 procedures on 39 patients with spontaneous pneumothorax. There were 24 males and 15 females with age ranging from 17 to 84 yr (mean 36.7). Indication for operation included recurrent pneumothorax in 20 (51 per cent), persistent pneumothorax in 16 (41 per cent) and bilateral pneumothorax in 3 (8 per cent). The main therapeutic strategies were apical pleurectomy, in all (42) and blebectomy/bullectomy in 38 (90 per cent). There was one hospital death (hospital mortality 2.5 per cent) in an elderly patient who developed multi organ failure post bullectomy and persistent air leak. One patient (2.5 per cent) required conversion to formal thoracotomy. Mean post-operative chest tube duration was 2.7 days and mean post-operative hospital stay was 5.1 days. There has been no recurrence of pneumothorax in this series during short term follow up (mean 18 months). Our experience indicates an expanding role for video-assisted thoracic surgery in the management of patients with spontaneous pneumothorax.

Published
1997
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4. Development and evaluation of a holistic surgical head and neck cancer post-treatment follow-up clinic using touchscreen technology-Feasibility study.

Author

Semple CJ, Lannon D, Qudairat E, McCaughan E, and McCormac R

Subjects
Adult, Aftercare, Aged, Ambulatory Care methods, Attitude to Computers, Cancer Survivors, Computers, Handheld statistics & numerical data, Feasibility Studies, Female, Humans, Male, Middle Aged, Oropharyngeal Neoplasms therapy, Patient Participation, Patient Satisfaction, Touch, Carcinoma, Squamous Cell therapy, Head and Neck Neoplasms therapy, Holistic Health, Mouth Neoplasms therapy, User-Computer Interface
Abstract

The efficacy of traditional follow-up care is being challenged, as cancer survivors' supportive and psychological needs are often neither identified, nor addressed. This study's aim was to develop a holistic surgical follow-up clinic for oral and oropharyngeal cancer patients were participants completed a disease-specific health-related quality of life tool (UWQOLv4) and item prompt list (Patient Concern Inventory) on a touchscreen computer. Information generated was used to focus the consultation on patient's identified needs and concerns. By means of a prospective non-randomised, pre-test post-test design, this follow-up clinic was evaluated using the patient enablement instrument (PEI) and patient content checklist (PCC). Feasibility was explored from the patient perspective (satisfaction survey) and clinician perspective (qualitative interview). Forty-four consecutive patients were recruited. Findings demonstrating five of the eight topics (overall QOL, emotions, head and neck symptoms, side-effects of treatment, chronic non-specific) on PCC were discussed more frequently, but changes were not statistically significant. The PEI highlighted a trend towards perceived improvement in four of the six items. Using touchscreen computers to aid communication during routine follow-up was reported as both feasible and beneficial by patients and clinicians. Providing a patient-focused follow-up consultation can facilitate the identification of unmet needs, permitting timely and appropriate intervention being initiated., (© 2018 John Wiley & Sons Ltd.)

Published
2018
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5. Which venous system to choose for anastomosis in head and neck reconstructions?

Author

Ross GL, Ang ES, Golger A, Lannon D, Addison P, Snell L, Novak CB, Lipa JE, Gullane PJ, and Neligan PC

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical methods, Female, Humans, Male, Microsurgery methods, Middle Aged, Retrospective Studies, Treatment Outcome, Jugular Veins surgery, Neck surgery, Neck Dissection methods, Plastic Surgery Procedures methods, Subclavian Vein surgery, Surgical Flaps blood supply
Abstract

It has been postulated that venous thrombosis in free flap surgery necessitates the use of 2 venous anastomoses into different venous systems. We retrospectively analyzed a single surgeon's 10-year experience (August 1993 to August 2003) in primary free flap reconstruction for malignant tumors of the head and neck. Of 492 primary reconstructions that did not need a vein graft, vein loop, or cephalic turnover procedure, 251 used the internal jugular venous system as venous outflow, 140 used the subclavian system as outflow, and 101 used both. Two hundred thirty-eight of 251 (95%) of flaps utilizing the internal jugular venous system for outflow were successful compared with 129 of 140 (92%) of flaps utilizing the subclavian system. Where both venous systems were used the success rate was 101 of 101 (100%) (P < 0.05). Where possible, a second venous anastomosis should be performed utilizing both venous drainage systems.

Published
2008
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6. Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis?

Author

Ross GL, Ang ES, Lannon D, Addison P, Golger A, Novak CB, Lipa JE, Gullane PJ, and Neligan PC

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Anastomosis, Surgical methods, Head and Neck Neoplasms surgery, Surgical Flaps blood supply
Abstract

Background: Successful free flap surgery in the head and neck is dependent on the successful anastomosis of both artery and vein. The success of all free flaps was analyzed to determine the necessity for performing 2 venous anastomoses., Methods: We retrospectively analyzed a single surgeon's 10-year experience (August 1993-August 2003) in free flap reconstruction for malignant tumors of the head and neck. Four hundred ninety-two free flaps were primary reconstructions that did not require a vein graft, vein loop, or cephalic turnover procedure. Three hundred forty-five flaps had 1 venous anastomosis, and 147 flaps had 2 venous anastomoses., Results: Overall, flap success was 468 of 492 (95.1%). Successful flap reconstruction in patients undergoing 2 venous anastomoses was 145 of 147 (98.6%) compared with 323 of 345 (93.6%) in patients undergoing 1 anastomosis (p < .05)., Conclusion: Where possible, a second venous anastomosis should be performed in head and neck free flap reconstruction.

Published
2008
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7. Compartment syndrome after closure of the anterolateral thigh flap donor site: a report of two cases.

Author

Addison PD, Lannon D, and Neligan PC

Subjects
Adult, Femoral Neoplasms surgery, Humans, Male, Muscle, Skeletal pathology, Muscle, Skeletal surgery, Necrosis etiology, Necrosis therapy, Osteosarcoma secondary, Osteosarcoma surgery, Pelvic Neoplasms surgery, Plastic Surgery Procedures adverse effects, Tissue Donors, Compartment Syndromes etiology, Surgical Flaps adverse effects, Thigh surgery, Thoracotomy adverse effects
Abstract

Two male sarcoma patients developed a compartment syndrome in the thigh after the harvest and direct closure of the anterolateral thigh flap donor site. In each case, the absence of signs or symptoms led to a delay in diagnosis and treatment. Although use of the anterolateral thigh flap is increasingly popular for soft tissue reconstruction, this complication has not yet been reported. The cases and likely etiological factors are discussed as are recommendations for avoiding this devastating complication.

Published
2008
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8. A ten-year experience of multiple flaps in head and neck surgery: how successful are they?

Author

Ross GL, Ang S W EE, Lannon D, Addison P, Golger A, Novak CB, Lipa JE, Gullane PJ, and Neligan PC

Subjects
Feasibility Studies, Follow-Up Studies, Graft Survival, Humans, Retrospective Studies, Head and Neck Neoplasms surgery, Surgical Flaps
Abstract

Ablative surgery in the head and neck often results in defects that require free flap reconstruction. With improved ablation/reconstructive and adjuvant techniques, improved survival has led to an increase in the number of patients undergoing multiple free flap reconstruction. We retrospectively analyzed a single institution's 10-year experience (August 1993 to August 2003) in free flap reconstruction for malignant tumors of the head and neck. Five hundred eighty-two flaps in 534 patients were identified with full details regarding ablation and reconstruction with a minimum of 6-month follow-up. Of these 584 flaps, 506 were for primary reconstruction, 50 for secondary reconstruction, 12 for tertiary reconstruction, and 8 patients underwent two flaps simultaneously for extensive defects. Overall flap success was 550/584 (94%). For primary free flap surgery, success was 481/506 (95%), compared with 44/50 (88%) for a second free flap reconstruction and 9/12 (75%) for a third free flap reconstruction ( P < 0.05). Eight extensive defects were reconstructed with 16 flaps, all of which were successful. More than one free flap may be required for reconstruction of head and neck defects, although success decreases as the number of reconstructive procedures increases.

Published
2008
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10. Video-assisted thoracic surgery (VATS) for spontaneous pneumothorax.

Author

McCarthy JF, Lannon D, McKenna S, and Wood AE

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Male, Middle Aged, Pneumothorax mortality, Postoperative Complications etiology, Postoperative Complications mortality, Recurrence, Survival Rate, Endoscopes, Pneumothorax surgery, Thoracoscopes, Video Recording instrumentation
Abstract

Video-assisted thoracic surgery (VATS) involves using a thoracoscope with a camera chip attached to a video monitor which allows certain thoracic procedures to be performed with limited incisions. Using VATS, 170 procedures have been performed on 158 patients including 42 procedures on 39 patients with spontaneous pneumothorax. There were 24 males and 15 females with age ranging from 17 to 84 yr (mean 36.7). Indication for operation included recurrent pneumothorax in 20 (51 per cent), persistent pneumothorax in 16 (41 per cent) and bilateral pneumothorax in 3 (8 per cent). The main therapeutic strategies were apical pleurectomy, in all (42) and blebectomy/bullectomy in 38 (90 per cent). There was one hospital death (hospital mortality 2.5 per cent) in an elderly patient who developed multi organ failure post bullectomy and persistent air leak. One patient (2.5 per cent) required conversion to formal thoracotomy. Mean post-operative chest tube duration was 2.7 days and mean post-operative hospital stay was 5.1 days. There has been no recurrence of pneumothorax in this series during short term follow up (mean 18 months). Our experience indicates an expanding role for video-assisted thoracic surgery in the management of patients with spontaneous pneumothorax.

Published
1997
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