Plastic Surgery Center Research Articles

A Retrospective Study of Antibiogram in One of the Largest Burn Center in Pakistan

Background and Objective: Jinnah Burn and Reconstructive Surgery Center, Lahore, Pakistan is one of largest burn patients management center in country. We evaluated our latest antibiogram of burn wounds to help patients and improve the healthcare. Methods: Retrospective observational study of burn patients. Our study included all kinds of burns and all admitted patients with all ages, total burn surface area 01-80%. Wound cultures and sensitivity done on wounds swabs by culture and disc diffusion methods. Results: There were 175 cases. Total six bacteria were found in all 175 cases. The Acinetobacter species were 9 (5.1%), Klebsiella species were 110 (62.8%) and these were most common ones, Proteus species were 12 (6.8%), Pseudomonas species were 30 (17.1%), Staphylococcus aureus were 12 (6.8%) and Staphylococcus coagulase negative were 2 (1.1%). Klebsiella was most sensitive to Colistin. All 105 out of 105 were sensitive (100.0%), followed by Tigercyclin; 39 out of 65 were sensitive (60.0%) and then Meropenum 47 out of 88 were sensitive (53.4%). Conclusion: Klebsiella is the most common organism found in cultures of burn wounds and Colistin shows best sensitivity results against all bacteria found in our reports including Klebsiella.

Effectiveness of dental care automation implementation in endodontic treatment of primary teeth

Relevance. The development of medical care quality control systems and implementation of medical information systems in dental services have recently been very relevant. Thus, research to increase the level of pediatric dental care through the implementation of modern medical information systems is paramount. Aim. The study aimed to improve the dental service quality control systems for primary teeth pulpitis treatment in children under seven years by implementing a medical information system. Material and Methods. According to the Protocols of management of children with dental diseases and clinical recommendations project „Pulpitis in children”, we comparatively assessed patient record documentation quality of 236 children under seven years who presented with diagnosis К04.03 „chronic pulpitis” to the pediatric dental clinic of the Clinical Centre for Maxillofacial, Plastic Surgery and Dentistry of the MSUMD in 2016 and 2018. Results. The study confirmed that medical information system ensures a higher quality of dental record documentation. Conclusion. A medical information system implementation significantly contributes to the improvement of the dental care quality control system.

Impact of COVID-19 on the patient referral pattern and conversion rate in the university versus private facial plastic surgery centers.

To compare the number of referrals and conversion rate between the pandemic and pre-pandemic period. The number of referrals and conversion rate between the 10-month pandemic (March-December 2020) and pre-pandemic (March-December 2019) were evaluated in the two university (mainly non-cosmetic) and private (mainly cosmetic) facial plastic surgery centers. Demographics and monthly number and type (cosmetic and non-cosmetic) of the referrals and surgeries were recorded from the both and cosmetic facial injections (botulinum toxin and filler) and the source of referrals (web- and non-web-based) from the private center. The conversion rate was a ratio of the number of the surgeries to the number of referrals. The number of referrals declined by 7.7% in the private center which was significantly higher for the non-cosmetic (26%) than the cosmetic (0.5%) referrals. It was 32% in the university center. The private center conversion rate significantly (P < 0.001) decreased for both the cosmetic (60%) and non-cosmetic (82%) procedures. It was not significantly different between the cosmetic (65%) and non-cosmetic (58%) procedures in the university center. However, the number of cosmetic facial injections (11%) and the web-based referral source (4%) increased. The recovery was better for the number of referrals (better in the private center) than the conversion rate. The fall in the conversion rate was statistically significant in the private center. While the number of referrals recovered to almost the pre-pandemic level, the conversion rates, despite recovery, remained at a lower level at the end.

575 Are More Patients Being Harmed Than Treated with VTE Prophylaxis in Plastic Surgery? A Single-Centre Cycled Audit Reviewing Prescribing Practices

Abstract Aim Venous thromboembolism prophylaxis (VTEP) was introduced following research showing that it was successful at preventing thrombotic complications in surgery patients. However, recent evidence demonstrates that patients in this cohort had subclinical venous thromboembolic disease and the benefit of VTEP was over-estimated. The Number Needed to Harm (NNH) is 26–67 while the Number Needed to Treat (NNT) is 147. This retrospective analysis attempted to identify if incorrect prescriptions in patients undergoing plastic surgery was possibly causing greater harm in a single plastic surgery centre. Method A retrospective analysis of the notes of all admissions in 1 month was conducted. VTEP forms and prescriptions were reviewed and compared against recommendations from the National Institute for Health and Care Excellence as well as local policy. A teaching session was delivered to explain to the department issues with prescriptions, then another 1 month of notes were analysed. Results Conclusion There was an over-prescription of VTEP in plastic surgery patients in our cohort leading to a potential greater number of harmed than treated patients. This may require an attitude change towards VTEP to reduce patient harm.

Effectiveness of an Interventional Program on Nurses Practices regarding Removing and Cleaning Burn Dead Tissue

Abstract &#x0D; Objective(s): The study aims to measure the effectiveness of the program on removing dead tissue for burn patients by testing the nurses before the program in addition to testing them again after implementing the educational program.&#x0D; Methodology: The study is quantitative in nature (one experimental) and will employ pre- and post-testing techniques between October 17, 2020 and March 20, 2022. A non-probability (purposive) sample of 24 nurses working in the Azadi Teaching Hospital's Burns and Plastic Surgery Center was chosen. The experimental survey of nursing practice, a literature review, scientific records, and previous research were all taken into consideration when developing the training program and study's conclusion. The program's information and tool are reviewed by sixteen experts representing a variety of areas, and the instrument's dependability is established through test and retest. The effectiveness of the nurse education program is evaluated using 22 clinical criteria for first burn treatment. In SPSS version 22, descriptive and inferential statistics are used to analyze the data.&#x0D; Results: The findings show that men between the ages of 30 and 39, graduates of high school, and people with less than five years of experience made up the vast majority of the sample. The majority of the samples participated in a burn course that was conducted in Iraq. In addition to significant comparisons, there were significant differences at P 0.01 in the removal of necrotic tissue and the cleaning of burns.&#x0D; Conclusions: study conclude that nurses practice regarding initial burn management improved due to implementing the suggested intervention program. &#x0D; Recommendations: the study recommends that providing of an educational program about removing and cleaning burn dead tissue as part of the curriculum in burns and plastic surgery center is essential.

Use of Tranexamic Acid in Liposculpture: A Double-Blind, Multicenter, Randomized Clinical Trial.

Intraoperative hemostasis should be performed with great caution because bleeding is a huge enemy of patient safety during surgery. Tranexamic acid is a lysine synthetic derivate that inhibits fibrinolysis and diminishes the bleeding by blocking the five lysine-binding sites for plasminogen. The authors compare the efficacy of tranexamic acid versus placebo as a hemostatic agent in liposculpture procedures. The authors conducted a multicenter, double-blind, randomized, controlled clinical trial in patients who were scheduled for liposculpture in three plastic surgery centers (Colombia and Mexico) between January of 2019 and February of 2020. One hundred forty-one patients were randomly assigned into three groups: intravenous (1 g of tranexamic acid), subcutaneous (1 g of tranexamic acid), and placebo (normal saline). Forty-seven patients were assigned to each group. There were 30 male patients and 111 female patients. The main outcome was to evaluate the amount of postoperative bleeding between groups. The primary outcome was measured by the hemoglobin point loss at day 1 (preoperative hemoglobin minus hemoglobin at day 1 postoperatively) and the hemoglobin (in milligrams per deciliter) point loss at day 5 (preoperative hemoglobin minus hemoglobin at day 5 postoperatively). The authors found the intravenous intervention group to have a greater hemoglobin level than the other two groups on both the first postoperative day ( p = 0.0001) and the fifth postoperative day ( p = 0.001). There were no statistical differences in hemoglobin values between the placebo and the subcutaneous intervention groups. Intravenous tranexamic acid is a good therapeutic choice to implement on liposculpture procedures to decrease postoperative bleeding. The preoperative use of intravenous tranexamic acid not only decreases the bleeding rate after liposuction procedures, but also allows greater lipoaspirate volumes when performing high-definition liposculpture. Further studies are required to support the effectiveness of tranexamic acid within the infiltration solution. Therapeutic, I.

RECONSTRUCTION OF TONGUE DEFECT WITH SUBMENTAL FLAP AFTER TUMOR RESECTION

Objectives: This study aims to evaluate the effectiveness of the reconstruction of tongue defects with submental flap after tumor resection. Methods: This is a retrospective and prospective study for 12 patients diagnosed with tongue cancer who underwent extensive tumor resection and reconstruction of tongue defects with submental flap at the Center for Craniofacial and Plastic Surgery - 108 Military Central Hospital, from January 2019 to March 2022. Results: The study included 10 male patients (83.3%) and 2 female patients (16.7%), with an average age of 54.83. The average size of the defect is 54.4x 30.2mm. The submental flap for reconstruction had an average size of 69.6x39.6mm. After surgery, the survival rate of the flap was 100%, partial necrosis was 7.1%, damage to the mandibular branch was 7.1%. Resumption of completely normal speech function accounted for 66.7%, normal diet accounted for 58.4%, no patient had completely lost speech or swallowing function. Conclusion: The submental flap has many advantages in reconstructing tongue defects after small-size tumor resection, including simple technique and suitable size. Reconstructive results show the good restoration of the patients' speech and swallowing functions.

Impact of an interventional program on nurses practices regarding initial burn management

Background: Serious burn injuries may have lifelong impacts for individuals that experience them and require timely management in order to reduce associated morbidity and mortality. Initial management of a burn is nursing intensive and focuses primarily on stopping the burning process, maintaining homeostasis by keeping the patient warm, and replacing lost fluid and electrolytes. As healing progresses, nurses meet the critical needs of the patient and must skillfully manage pain levels, perform burn care, prevent infection, help the patient meet increased nutrient requirements, and address psychological concerns with the goal to restore health and function to the highest possible level, thus the aim of this study is evaluate nurse's practices regarding initial burns management. Methodology: A quantitative (one pre experimental) design had been adapted through the present study with the application of pre-posttest approach during the period of 17th October, 2020 to 20th March, 2022. A non-probability (convenient) sample of 24 nurses who work at burns and plastic surgery center at Azady teaching hospital. The interventional program and study instrument is designed based on of the nurse's practice assessment need, review of literature, scientific lecturer and previous study.

Versatility and reliability of reverse posterior interosseous artery flap for coverage of soft tissue defects of hand and wrist.

Objective: To evaluate reverse PIA flap in reconstruction of various types of soft tissue defects of the hand in terms of reliability, flap survival, total duration of hospital stay, patient’s satisfaction and duration of return to work Study Design: Case Series study. Setting: Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: January 2018 to July 2020. Material &amp; Methods: Twenty three posterior interosseous artery flaps were used for coverage in patients who had soft tissue defects over hand dorsum, wrist and first web space. Both sexes were included with age group ranging between 15 to 60 years. Results: Twenty two flaps, out of total 23 survived completely. In one patient, there was partial flap necrosis for which skin grafting was done. Donor sites were successfully covered with skin grafts. All patients went on to resume their work within a month or two and were quite satisfied with aesthetic outcome. Conclusion: A well planned reverse PIA flap is not only a safe, versatile and reliable option for coverage of hand defects but also entire has the benefit of a shorter hospital stay, allowing early return of patient to work and superior aesthetic outcome.

Interventional Program on Nurses Practices Regarding Burn Wound Dressing

Background: Wound management is a crucial aspect of patient care and the nurse often is faced with the question of which approaches to use to provide an environment that supports healing and prevents complications. Important questions include how different types of wounds should be dressed, what method of debridement to use, whether dressings should be changed using sterile versus unsterile technique, and which adjunctive therapies to select under given circumstances, thus the aim of this study is to evaluate the effect of an intervention program on nurse's practices regarding dressing burn wound. Methodology: A quantitative (one pre experimental) design had been adapted through the present study with the application of pre- post-test approach during the period of 17th October, 2020 to 20th March, 2022. A non-probability (convenient) sample of 24 nurses who work at burns and plastic surgery center at Azady teaching hospital. The interventional program and study instrument is designed based on of the nurse's practice assessment need, review of literature, scientific lecturer and previous study. The content of the program and instrument are evaluated by 16 experts in different field and the reliability of instrument is determined through the use of test and retest, measurement of effectiveness for nursing education program carried out through (24) items concerning clinical guidelines regarding burn management. The analysis of data is performed through the application of descriptive statistic as well as inferential statistic by using statistical package of social science version 22. Result: shows that vast majority of the sample were male, 30-39 years old, high school graduate, less than 5 years of experience. Most of the samples participate in burn courses, one course in number, their courses inside Iraq. Comparisons significant at P&lt;0.01 was high regarding initial survey’s, secondary survey's, total body surface, initial assessment of the depth of the burn wounds, burn wounds, removing dead tissue and cleaning the burn's. Conclusion: study conclude that Nurses' Practice improvements due to applying of the proposed interventional program with relative to demographical characteristics. The study recommends that nurses practice toward burn management should be updated periodically as well as encourage nurses to participate in sessions, conferences and seminar related to care of burn Keywords: Burns; Hydrogels; Peptides; Wound dressings, Skin

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Efficacy of topical steroid in treatment of hyper granulation tissue in burn patients: A randomized control trial.

Objective: To determine the efficacy of topical steroid in treatment of hyper granulation tissue in burn patients in term of healing time. Study Design: Randomized Control Trial (RCT). Setting: Jinnah Burn &amp; Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore. Period: May 2017 to November 2017. Material &amp; Methods: A total of 32 patients fulfilling the inclusion criteria were enrolled in the study. Patients were randomly divided into 2 groups with 16 patients in each group by lottery method. Written informed consent was obtained from all patients. In group A, topical 1% hydrocortisone (Fusidin H) cream was applied and Group B received Medicated Paraffin gauze (bactigrass) dressing. Wound assessment was done weekly by 2 consultant plastic surgeons and final assessment was done at 3weeks after the treatment. Results: The mean age of patients was 28.6 + 8.81 years, among them 22(68.8%) were male and 10(31.3%) were females. Mean healing time in Group A and Group B was 12.8 +2.08 days and 15.4+1.6 days respectively. Efficacy was calculated as P value of 0.12 which is significant (p &lt; 0.05). Conclusion: Topical steroid (hydrocortisone 1%) is more effective in treatment of hyper granulation in post burn wounds with early healing than medicated paraffin gauze dressing.

Discussion: Genetic Influence on Neurodevelopment in Nonsyndromic Craniosynostosis.

Boston, Mass. From the Department of Surgery, Massachusetts General Hospital; and Pediatric Plastic Surgery and Cleft Center, Harvard Medical School. Received for publication July 10, 2021; accepted December 7, 2021. Disclosure:The authors have no financial interest to declare in relation to the content of this Discussion or of the associated article. Eric C. Liao, M.D., Ph.D., Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC Suite 435, Boston, Mass. 02114, [email protected], Instagram: @ericliaomd, Twitter: @ericliaomd

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center's Shift of Indications.

Background:Since its outbreak, the COVID-19-pandemic has had a tremendous impact on healthcare systems worldwide. We conducted a comparative study to analyze the pandemic’s consequence on microsurgical reconstructions at a reconstructive plastic surgery center in Sweden.Method:All free flaps performed at a single center between March 2019 and 2021 were analyzed. The patient cohort was divided into two groups, with a period of 1 year in each group: non-COVID-19 year and COVID-19 year. The periods were compared regarding the number and type of surgeries and patient characteristics.Results:In the year prior to the pandemic, 123 free flap surgeries were performed, compared with 103 surgeries during the COVID-19 year. There was a significant shift in the most common site for free flap reconstruction: from the breast [which decreased by 42% (66–38)] to head and neck [which increased by 22% (41–50); OR 0.53 (P = 0.02)]. This was also reflected by a significant increase in hospital stay for free flap patients during the COVID-19 year (P = 0.02).Conclusions:During the COVID-19 pandemic, a shift was seen from breast reconstructions toward head and neck reconstructions as the most common free flap procedure performed. An increasing backlog of elective breast reconstructions demands increased resources and tougher priorities, which challenge the healthcare system in the post-COVID-19 era.

Investigating Gender Differences in Canadian Plastic Surgery Online Patient Education.

The public interest and demand for cosmetic surgery is growing in North America. As practices continue to advertise cosmetic procedures, male consumers must also be given fair consideration in a market targeted mostly towards women. This study investigated the advertising trends of plastic surgery clinics to assess for prevailing gender differences among online Canadian plastic surgery practice advertising. The 2021 College of Physicians and Surgeons directory for each province and territory was utilized to identify all practicing plastic surgeons. A systematic search with Google (Mountain View, CA) was conducted to analyze the websites of Canadian plastic surgery centers in the following manner: "[physician name] [province of practice]." A total of 209 websites and 13,838 images were identified and analyzed. Of these images, 12,386 (90%) were female and 1452 (10%) were male patients or models. Although only 20% had a male services page, 62% of all centers offered gynecomastia procedures. The most common procedures targeting men were blepharoplasty (95%), liposuction (93%), and abdominoplasty (93%). The Prairies region had significantly fewer websites with male-only pages compared with all other Canadian regions. Despite the increase in cosmetic surgery procedures for males, the market for cosmetic surgery procedures targeted towards males remains insignificant. An increase in the advertising of in-demand male cosmetic procedures can allow for a broader consumer market and a subsequent increase in benefits for plastic surgeons.

Symptom improvement with mirabegron treatment is associated with urobiome changes in adult women

Introduction and hypothesisMirabegron, a beta-3 agonist, is prescribed for urgency urinary incontinence (UUI). We assessed the correlation of symptom improvement with urobiome characteristics in adult women participants prescribed mirabegron for UUI treatment.MethodsWe enrolled participants seeking UUI treatment who selected mirabegron and agreed to participate in this 12-week, open label study conducted at the Female Pelvic Medicine and Reconstructive Surgery Center at Loyola University Medical Center. Following eligibility screening and research consent, participants completed the overactive bladder questionnaire (OAB-Q) and provided a catheterized urine sample at baseline, 4, 8, and 12 weeks. The primary outcome, symptom improvement at 12 weeks, was based on the validated Patient Global Symptom Control questionnaire score to dichotomize symptom response (responder vs nonresponder [PGSC score ≤3]). Urine samples were processed by the Expanded Quantitative Urine Culture (EQUC) protocol.ResultsEighty-three participants (mean age 68 years) completed baseline assessment. Of the 47 participants with primary outcome data and samples analysis, there were 16 responders and 31 nonresponders; responder groups were similar demographically. Living microbes were detected in most participants. There were no significant differences in alpha diversity (within sample) at baseline between groups. However, at the 12-week follow-up, the responder urobiome became significantly richer, with a larger number of genera (p = 0.027) and was significantly more diverse than the nonresponders.ConclusionsLongitudinal urobiome changes are associated with symptom improvement in adult women being treated with mirabegron for UUI. The mechanism for symptoms improvement may relate to the detected changes in the urobiome and warrants further study.

A.E. Belousov. Practical Reconstructive and Aesthetic Surgery (St. Petersburg, 1998)

At the end of 1998, the publishing house "Hippocrates" published the book "Plastic, Reconstructive and Aesthetic Surgery" under the general editorship of a well-known surgeon, Director General of the Center for Plastic and Reconstructive Surgery (St. Petersburg), laureate of the State Prize Professor A.E. Belousov. This is a joyful and welcome event, especially for those specialists who studied and improved in the field of reconstructive microsurgery according to the previous book by A.E. Belousov, written in collaboration with prof. S.S. Tkachenko, "Microsurgery in traumatology" (L., "Medicine", 1988).

Leçons d’un maître en déplacement de tissus : études des carnets opératoires du médecin général Gustave Ginestet dans ses années Foch (1945–1959)

The surgical notebooks (1945-1959) of General Gustave Ginestet are the last direct testimony of the quintessential period in which autoplastic techniques were used, before their twilight, favored by the advent of axial pedicle flaps, musculocutaneous flaps and later free flaps. They summarize all the refinements of the experience accumulated at the National Center for Reconstructive Surgery (Centre Médico-Chirurgical Foch-Suresnes). They appear to be more informative than the various books of the time, which were intended for an experienced public or for those benefiting from a companionship, thus eluding a certain number of precautionary advice, which are undoubtedly tacit but essential to obtain a successful operation in the hypothesis of their current use. This paper aims to establish the principles of historical surgical techniques and to integrate them into the management of patients in therapeutic impasse. One hundred and seven clinical situations requiring tissue displacement were analyzed by reconstructed region and by type of flap used. This technical view of the past, as close as possible to the daily practice of a famous reconstructive surgery center, does not offer absolute methodological or technical precepts. From the surgical notebooks studied, the only thing that emerges is a rigorous approach that allows us to contain a permanent doubt and an experimental process. This notion of constant evolution of the autoplastic practice, guided by its errors, intuitions and beliefs, highlights the importance of a surgical culture, which, with a humanistic approach, must be nourished by the paths of the past.

314 Biodegradable Temporising Matrix (BTM) Use in a Traumatic Chest Wound: A Case Report

Abstract We describe the innovative use of biodegradable temporising matrix (BTM) in a large traumatic chest wound in a 23-year-old lady at the Welsh Centre for Burns and Plastic Surgery. The wound was sustained after the patient fell from a tractor into a large silage rake, resulting in injuries to her chest and limbs. Following meticulous debridement, the resulting full thickness skin defect measured 30x30 cm extending from the sternal notch to the upper abdomen, with bone, muscle, and breast tissue exposure. No donor sites for free flap reconstruction were available due to the limb injuries. BTM is a recently developed synthetic dermal substitute and has been utilised to achieve soft tissue coverage in complex wounds i.e., post debridement in burns, traumatic injuries, and necrotising fasciitis. It was used in this case as it confers a number of advantages against skin graft alone such as reduced susceptibility to contracture and the ability to cover small areas of exposed bone. It also demonstrates reduced susceptibility to infection compared with other dermal substitutes. To our knowledge, this is the first use of BTM to cover breast tissue. The central chest is a difficult anatomical region to reconstruct due to the importance of maintaining breast contour and avoiding wound contracture and deformity. The patient was closely followed up in dressing clinic and application of split skin autograft over the delaminated achieved an aesthetically excellent and functionally result, with breast contour maintained and full range of movement at the axilla.

371 Use of Trello as a Project Management Tool for Collaborative Surgical Research and Audit

Abstract Introduction Managing surgical research projects alongside clinical commitments requires organisation, prioritisation, and communication. Our unit is a tertiary plastic surgery centre with a large workforce, high volume case load and abundant research opportunity. In a busy department, co-ordination and communication is imperative for timely high-quality research and audit output and maximum productivity. Tools can be used to support this output; we trialled use of Trello project management software to increase productivity in this context. Method We set up a Trello account for our unit’s plastic surgery department. All consultants and trainees have access, and each project has a timeline and standardised progress checklist to support completion of projects to a uniform high standard. Results Our Trello for Surgical Research pilot has promoted organised collaborative working and reduced duplication and partial completion of audit and research projects within our department. It has encouraged engagement between smaller subgroups within the unit, and a platform to monitor progression through key stages of project development with oversight of an appointed Research Lead, resulting in an increase in completion of closed loop audits and research projects. Conclusions Similar experiences have been described in mathematics and engineering research groups, and delivery of educational material for English Literature study, but we have not identified description of Trello as a tool for medical research. Use of such platforms increases productivity and likelihood of completion of projects, as well as providing a clear outline of a departments’ research priorities and accessible opportunities for rotating juniors.