Cochrane Database of Systematic Reviews Absorbable versus non-absorbable sutures for skin closure... more Cochrane Database of Systematic Reviews Absorbable versus non-absorbable sutures for skin closure a er carpal tunnel decompression surgery (Review) Wade RG, Wormald JCR, Figus A Wade RG, Wormald JCR, Figus A. Absorbable versus non-absorbable sutures for skin closure a er carpal tunnel decompression surgery.
Journal of Plastic Reconstructive and Aesthetic Surgery, Mar 1, 2022
BACKGROUND When patients are unsuitable for deep inferior epigastric perforator (DIEP) flap breas... more BACKGROUND When patients are unsuitable for deep inferior epigastric perforator (DIEP) flap breast reconstruction, the inferior gluteal artery perforator (IGAP) flap has been used as an alternative option. However, the profunda artery perforator (PAP) flap is also gaining popularity as an alternative to the DIEP flap for several reasons. This retrospective cohort study compares baseline characteristics, peri- and post-operative outcomes following IGAP flap and PAP flap breast reconstructions after mastectomy for cancer. METHODS In a single center in the UK, from September 2008 through December 2016, 43 women underwent IGAP Flap(s) breast reconstruction and 51 received PAP flap(s) breast reconstructions. Statistical analysis was performed to compare baseline, peri-operative and post-operative variables between the two reconstruction methods. RESULTS Perioperative complications requiring reoperation were experienced in women undergoing IGAP flap breast reconstructions only (21% versus 0%, p = 0.001), principally due to the risk of total flap failure (12% versus 0%, p = 0.01). Women undergoing IGAP flap breast reconstructions were at significantly higher odds of revision surgery (OR 17 [95% CI: 5.5-53], p < 0.001), which was unchanged after adjusting for bilateral reconstructions (adjusted OR 18 [95% CI: 5.3-58], p < 0.001). CONCLUSIONS PAP flaps appear to be associated with significantly fewer complications and revision surgeries than IGAP flaps for breast reconstruction in women undergoing mastectomy for cancer and who are unsuitable for a DIEP flap breast reconstruction.
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Journal of Plastic, Reconstructive & Aesthetic Surgery
BACKGROUND Safety of reconstructive microsurgery in elderly patients is still a topic of debate, ... more BACKGROUND Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8). METHODS A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-related, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models. RESULTS Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population. CONCLUSIONS Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Introduction/Background This study aimed to evaluate the application of Keystone perforator islan... more Introduction/Background This study aimed to evaluate the application of Keystone perforator island flaps (KPIF) technique, complications and long-term results in vulvovaginal reconstruction after wide vulvar surgery. Methodology This is the first case series describing the technique of Keystone perforator island flaps to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, intraoperative, early and late complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyze in the follow up. Results Between December 2016 and July 2018, 5 patients were selected for the study: four patients underwent radical vulvectomy for squamous cell vulvar cancer and one underwent a vulvar wide excision for Paget disease, in all cases a reconstruction with KPIF technique followed the demolitive surgery. The defects were successfully covered by the key stone flap technique in all patients. There were no major intraoperative complications and early postoperative complications such as suture dehiscence occurred in only one patient, suffered a partial dehiscence of the wound. None skin flaps necrosis were observed. All patients were functionally and aesthetically satisfied in the long term. Conclusion Keystone flaps seems to be easy to design, elevate, and offer rapid fasciocutaneous closure in wide vulvo-perineal defect, with few intraoperative, early and late complications and excellent long-term results. Disclosure Nothing to disclose
This study aimed to evaluate the application of the Keystone flap technique and the long-term res... more This study aimed to evaluate the application of the Keystone flap technique and the long-term results of vulvovaginal reconstruction after vulvar surgery. Methods: This is the first case series describing the application of the Keystone perforator island flaps (KPIF) technique to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyzed in the follow up. Results: Five patients were selected for the study: four underwent radical vulvectomy for squamous cell vulvar cancer, and one underwent vulvar wide excision for Paget disease followed by reconstruction with the Keystone flap technique. The defects were successfully covered by the Keystone flap technique in all patients. Conclusions: Keystone flaps seem to be easy to design and elevate, and it offers rapid fasciocutaneous closure in wide vulvo-perineal defects with excellent long-term results.
We read this article with great interest. This converted audit-cum-research study provided some g... more We read this article with great interest. This converted audit-cum-research study provided some good evidence that the role of the dermis in Dupuytren's contracture may be more significant than previously thought. The authors state a dermal fibromatosis rate of 61% in their cohort, which they believe is an underestimate due to missed pathology caused by a small biopsy sample dimensions and preparation method. The authors go on to suggest that skin biopsies preoperatively may be useful for determining intervention methods; fasciotomy or dermofasciotomy. We believe that this suggestion is not without merit and its implementation would be more straightforward than it may initially appear. Multiple centres in the United Kingdom currently employ a same-day, one-stop service for dermatology, which includes biopsies, therefore, a Dupuytren's punch biopsy service could be implemented alongside the current services without much disruption or capital expenditure. As mentioned, £41 million is currently spent by the NHS on Dupuytren's treatments. We believe the extra cost of histopathological analysis of punch biopsies (currently at ~£120) would be more than offset by the reduced rates of recurrence, which would invariably come from patients with sub-clinical dermal involvement obtaining the correct management. As the authors mention, clinical examination cannot be relied upon to accurately assess dermal involvement. What is ideally required, is a prospective study to determine whether or not punch-biopsy-guided intervention is superior to clinically guided intervention, the outcomes being range of movement and requirement for re-operation. The difficulties with this study would be defining what constitutes dermal involvement on biopsy and ensuring that inclusion/ exclusion criteria are suitable, so results could be generalized. Nevertheless, a well planned and executed study would potentially be practice altering.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013
The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr ... more The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg 2007;120(6): 1466e76. 3. Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 1999;104(3): 748e59 [discussion 760e3]. 4. James A, Verheyden C. A retrospective study comparing patient outcomes of wise pattern-inferior pedicle and vertical patternmedial pedicle reduction mammoplasty. Ann Plast Surg 2011; 67(5):481e3.
Although Dupuytren’s disease of the thumb was first described in 1833, the literature on this sub... more Although Dupuytren’s disease of the thumb was first described in 1833, the literature on this subject is limited to a few anatomical and clinical studies. This study examined the pattern of cords of Dupuytren’s disease in 260 thumbs in 181 consecutive patients with evidence of disease relating to the thumb attending an out-patient clinic over a period of 36 months. Discrepancies in the literature are discussed in the light of the findings of this more detailed analysis and a simple but practical pictorial system for recording disease severity and detailing progression over time is presented.
The digital nail complex is occasionally involved by squamous cell carcinoma. The published liter... more The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.
This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1... more This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1 and 2 of the fingers which had ruptured. Between June 1989 and May 2003, a total of 62 fingers in 61 patients presented with ruptured flexor tendon repairs within 48 hours from rupture. Immediate re-repair and rehabilitation was carried out in 44 fingers (71%) in 43 (70%) patients. Thirty-six patients completed the 8-week therapy programme after re-repair in 37 fingers. Nine (24%) had excellent, 10 (27%) good, 5 (14%) fair and 13 (35%) had poor results when assessed by the original Strickland method. Five fingers in five patients ruptured the re-repair. Poor results and second ruptures were particularly common after re-repair of ruptured tendon repairs in the little finger. In the light of these findings, a policy for dealing with ruptured primary flexor tendon repairs in the fingers is suggested.
Cochrane Database of Systematic Reviews Absorbable versus non-absorbable sutures for skin closure... more Cochrane Database of Systematic Reviews Absorbable versus non-absorbable sutures for skin closure a er carpal tunnel decompression surgery (Review) Wade RG, Wormald JCR, Figus A Wade RG, Wormald JCR, Figus A. Absorbable versus non-absorbable sutures for skin closure a er carpal tunnel decompression surgery.
Journal of Plastic Reconstructive and Aesthetic Surgery, Mar 1, 2022
BACKGROUND When patients are unsuitable for deep inferior epigastric perforator (DIEP) flap breas... more BACKGROUND When patients are unsuitable for deep inferior epigastric perforator (DIEP) flap breast reconstruction, the inferior gluteal artery perforator (IGAP) flap has been used as an alternative option. However, the profunda artery perforator (PAP) flap is also gaining popularity as an alternative to the DIEP flap for several reasons. This retrospective cohort study compares baseline characteristics, peri- and post-operative outcomes following IGAP flap and PAP flap breast reconstructions after mastectomy for cancer. METHODS In a single center in the UK, from September 2008 through December 2016, 43 women underwent IGAP Flap(s) breast reconstruction and 51 received PAP flap(s) breast reconstructions. Statistical analysis was performed to compare baseline, peri-operative and post-operative variables between the two reconstruction methods. RESULTS Perioperative complications requiring reoperation were experienced in women undergoing IGAP flap breast reconstructions only (21% versus 0%, p = 0.001), principally due to the risk of total flap failure (12% versus 0%, p = 0.01). Women undergoing IGAP flap breast reconstructions were at significantly higher odds of revision surgery (OR 17 [95% CI: 5.5-53], p < 0.001), which was unchanged after adjusting for bilateral reconstructions (adjusted OR 18 [95% CI: 5.3-58], p < 0.001). CONCLUSIONS PAP flaps appear to be associated with significantly fewer complications and revision surgeries than IGAP flaps for breast reconstruction in women undergoing mastectomy for cancer and who are unsuitable for a DIEP flap breast reconstruction.
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Journal of Plastic, Reconstructive & Aesthetic Surgery
BACKGROUND Safety of reconstructive microsurgery in elderly patients is still a topic of debate, ... more BACKGROUND Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8). METHODS A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-related, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models. RESULTS Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population. CONCLUSIONS Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Introduction/Background This study aimed to evaluate the application of Keystone perforator islan... more Introduction/Background This study aimed to evaluate the application of Keystone perforator island flaps (KPIF) technique, complications and long-term results in vulvovaginal reconstruction after wide vulvar surgery. Methodology This is the first case series describing the technique of Keystone perforator island flaps to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, intraoperative, early and late complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyze in the follow up. Results Between December 2016 and July 2018, 5 patients were selected for the study: four patients underwent radical vulvectomy for squamous cell vulvar cancer and one underwent a vulvar wide excision for Paget disease, in all cases a reconstruction with KPIF technique followed the demolitive surgery. The defects were successfully covered by the key stone flap technique in all patients. There were no major intraoperative complications and early postoperative complications such as suture dehiscence occurred in only one patient, suffered a partial dehiscence of the wound. None skin flaps necrosis were observed. All patients were functionally and aesthetically satisfied in the long term. Conclusion Keystone flaps seems to be easy to design, elevate, and offer rapid fasciocutaneous closure in wide vulvo-perineal defect, with few intraoperative, early and late complications and excellent long-term results. Disclosure Nothing to disclose
This study aimed to evaluate the application of the Keystone flap technique and the long-term res... more This study aimed to evaluate the application of the Keystone flap technique and the long-term results of vulvovaginal reconstruction after vulvar surgery. Methods: This is the first case series describing the application of the Keystone perforator island flaps (KPIF) technique to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyzed in the follow up. Results: Five patients were selected for the study: four underwent radical vulvectomy for squamous cell vulvar cancer, and one underwent vulvar wide excision for Paget disease followed by reconstruction with the Keystone flap technique. The defects were successfully covered by the Keystone flap technique in all patients. Conclusions: Keystone flaps seem to be easy to design and elevate, and it offers rapid fasciocutaneous closure in wide vulvo-perineal defects with excellent long-term results.
We read this article with great interest. This converted audit-cum-research study provided some g... more We read this article with great interest. This converted audit-cum-research study provided some good evidence that the role of the dermis in Dupuytren's contracture may be more significant than previously thought. The authors state a dermal fibromatosis rate of 61% in their cohort, which they believe is an underestimate due to missed pathology caused by a small biopsy sample dimensions and preparation method. The authors go on to suggest that skin biopsies preoperatively may be useful for determining intervention methods; fasciotomy or dermofasciotomy. We believe that this suggestion is not without merit and its implementation would be more straightforward than it may initially appear. Multiple centres in the United Kingdom currently employ a same-day, one-stop service for dermatology, which includes biopsies, therefore, a Dupuytren's punch biopsy service could be implemented alongside the current services without much disruption or capital expenditure. As mentioned, £41 million is currently spent by the NHS on Dupuytren's treatments. We believe the extra cost of histopathological analysis of punch biopsies (currently at ~£120) would be more than offset by the reduced rates of recurrence, which would invariably come from patients with sub-clinical dermal involvement obtaining the correct management. As the authors mention, clinical examination cannot be relied upon to accurately assess dermal involvement. What is ideally required, is a prospective study to determine whether or not punch-biopsy-guided intervention is superior to clinically guided intervention, the outcomes being range of movement and requirement for re-operation. The difficulties with this study would be defining what constitutes dermal involvement on biopsy and ensuring that inclusion/ exclusion criteria are suitable, so results could be generalized. Nevertheless, a well planned and executed study would potentially be practice altering.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013
The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr ... more The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg 2007;120(6): 1466e76. 3. Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 1999;104(3): 748e59 [discussion 760e3]. 4. James A, Verheyden C. A retrospective study comparing patient outcomes of wise pattern-inferior pedicle and vertical patternmedial pedicle reduction mammoplasty. Ann Plast Surg 2011; 67(5):481e3.
Although Dupuytren’s disease of the thumb was first described in 1833, the literature on this sub... more Although Dupuytren’s disease of the thumb was first described in 1833, the literature on this subject is limited to a few anatomical and clinical studies. This study examined the pattern of cords of Dupuytren’s disease in 260 thumbs in 181 consecutive patients with evidence of disease relating to the thumb attending an out-patient clinic over a period of 36 months. Discrepancies in the literature are discussed in the light of the findings of this more detailed analysis and a simple but practical pictorial system for recording disease severity and detailing progression over time is presented.
The digital nail complex is occasionally involved by squamous cell carcinoma. The published liter... more The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.
This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1... more This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1 and 2 of the fingers which had ruptured. Between June 1989 and May 2003, a total of 62 fingers in 61 patients presented with ruptured flexor tendon repairs within 48 hours from rupture. Immediate re-repair and rehabilitation was carried out in 44 fingers (71%) in 43 (70%) patients. Thirty-six patients completed the 8-week therapy programme after re-repair in 37 fingers. Nine (24%) had excellent, 10 (27%) good, 5 (14%) fair and 13 (35%) had poor results when assessed by the original Strickland method. Five fingers in five patients ruptured the re-repair. Poor results and second ruptures were particularly common after re-repair of ruptured tendon repairs in the little finger. In the light of these findings, a policy for dealing with ruptured primary flexor tendon repairs in the fingers is suggested.
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