Reconstructive Surgery Research Articles

Perceptions and Understanding of Transgender Patient Care: A Survey of Practicing Facial Plastic Surgeons.

Transgender individuals face significant health disparities including deficiencies in physician education, knowledge, and comfort with care. The objective of this study was to determine the perceptions, practice patterns, and familiarity of facial plastic surgeons with transgender health care. An anonymous questionnaire was sent to facial plastic surgeons within the American Academy of Facial Plastic and Reconstructive Surgery list-serve. Primary datapoints included participant characteristics, transgender-related experience, and educational goals. Of the 66 facial plastic surgeons surveyed, 49% had treated 1 to 10 transgender patients during their career, and 70% were actively treating at least 1 transgender patient. The number of patients treated and surgeries performed was significantly associated with self-perceived competence, comfort counseling on gender-affirming surgeries, discussing gender identity, asking preferred pronouns, and a desire to learn more about transgender care. Most participants (61%) obtained transgender care training through real-world experience, with only 18% receiving formal training in residency or fellowship. In total, 50% of respondents believe transgender care training among facial plastic surgeons is inadequate and 60% support its incorporation into residency/fellowship curricula. Increased awareness is needed to address the disparities experienced by transgender patients. Many facial plastic surgeons desire to learn more and support incorporating transgender care into training. Understanding the current state of transgender care can assist the facial plastic community in promoting education that strengthens physicians' ability to deliver competent care that addresses the inequities faced by this diverse group.

Preconditioning Local Injection of Activated Platelet-Rich Plasma Increases Angiogenesis, VEGF Levels, and Viability of Modified McFarlane Flap in Diabetes-Induced Rats

Background The risk of flap necrosis in tissue reconstruction surgery is elevated in patients with vascular disorders, such as diabetes mellitus. Chronic hyperglycaemia causes endothelial cell dysfunction and increases inflammatory process, causing vascular insufficiency. Platelet-rich plasma (PRP) contains high levels of platelets, growth factors and fibrinogens. Its regenerative properties spark interest in supporting flap survival in relation to diabetic complications. Methods Thirty Wistar rats were divided into three groups. The first group included diabetic rats without PRP injection, which underwent flap procedure. The second group included diabetes-induced rats receiving PRP subcutaneous injection one day prior to flap procedure. The third group included non-diabetic rats receiving PRP injection one day prior to flap procedure. Flap tissue samples were taken on the seventh day to measure VEGF levels using enzyme-linked immunosorbent assay (ELISA) method; angiogenesis and collagen density were measured from histopathology examination, and flap viability was analysed using digital measurements. Results Analysis showed that flap viability, angiogenesis and VEGF levels were significantly higher in the PRP-injected diabetic rats compared to diabetic rats that did not receive PRP. The levels of VEGF, angiogenesis and viability of flaps in diabetic rats given PRP did not differ significantly compared to non-diabetic rats that received PRP. Conclusion Flap preconditioning through local injection of activated PRP enhances flap viability, VEGF levels and angiogenesis, in random skin flaps in diabetic rats, to the level where it does not differ significantly to non-diabetic rats that were given PRP. Keywords. Platelet-rich plasma, diabetes mellitus, VEGF, angiogenesis, random skin flap

The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery.

To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold. We conducted a retrospective analysis on clinical data from patients who underwent medial canthal skin redundancy reconstruction surgery from September 2019 to January 2023. The surgical procedure involved a preoperative design for the incision line, suborbicularis oculi dissection to create a muscle flap, and the use of a reverse Z-flap for the reconstruction of the lateral canthal fold. Postoperative follow-up assessments focused on the intercanthal distance, positional changes of the medial canthus point, alterations in the medial canthus angle, and patient satisfaction levels. The statistical evaluation was carried out utilizing paired t-tests, with a P-value of less than 0.05 denoting statistical significance. Postsurgery, the lacrimal prominences were less exposed, and inner canthal angles naturally reshaped. Inconspicuous scarring with diminished reverse Z-plasty marks was noted within 3 months. The average ICD has increased by 3 to 6mm, corresponding to elongation ratios of 9.09% to 28.30%. Preoperatively, the ICD averaged 31.25±2.32mm, expanding postoperatively to 35.19±2.26mm. The canthal angle enlarged significantly from 49.031±6.627 to 62.188±6.662. Inner canthal points shifted notably postsurgery, with a decrease in x-value and an increase in y-value, signalling a movement upwards and away from the nose. Patient satisfaction is high. The reverse Z-plasty technique has proven to be an effective approach for reconstructing the epicanthal fold. The clarity and precision of the incision design, coupled with the stability of postoperative results, demonstrate that this method can reliably achieve successful epicanthal fold reconstruction.

An algorithmic approach to scalp reconstructive surgery: maximization of cosmetic and functional outcomes.

Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients. To provide an algorithmic approach and general guidelines to consider when deciding on which scalp surgery will optimize cosmetic and functional outcomes. Previous literature was searched for the last 20 years to provide an updated guide. Taking into consideration the location, size and local scalp anatomy of a presenting defect will lead to optimal surgical outcomes. Other confounding factors such as bone exposure and extremely large defects will affect decision making. An algorithmic approach has been provided in this review. While many reconstructive surgical options are available, the best ones will depend on individual presentation of scalp defects. Location and size are first line considerations while local scalp anatomy will allow for tailoring of reconstructive options. This will help to maximize cosmetic and aesthetic considerations.

Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis.

Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR. This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model. A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; P = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; P = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; P = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; P = 0.001). This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.

Public-Private Partnership: Optimising the Outcomes for Plastic Surgery in a Resource-Limited Setting at the University of Port Harcourt, (UPTH) Rivers State, Nigeria

Background: Public Private Partnership (PPP) refers to a form of cooperation between public authorities and the world of business which aims to ensure the funding, construction, renovation, management and maintenance of an infrastructure or the provision of better services, better quality, better and better health in a relatively cost- effective manner or approach to the society.  Aim and Objectives: This paper highlights the role of PPP in optimizing outcomes for patients who require plastic surgical services.  Materials and Methods: This study was carried out to bring to light the perennial problems of the health care mixes within a period of 6 months in the Plastics and Reconstructive Surgery unit of The University of Port Harcourt Teaching Hospital. This work looked at the Public Private sector mixes in health care system using Nigeria as a case study.  Results: Cases managed at the public facility alone, cases managed at the private facility alone and the cases managed through the combined effort of both the Private and Public sector (PPP) were analyzed.  Conclusion: Public Private Partnership is key to the success and effectiveness of healthcare delivery in a resource poor setting as the PPP drives the marriage of effectiveness in administration and business prototype in the marriage of government infrastructure and large medical market with turn over into a partnership where the private component brings in the specific funding and equipment and expertise needed to make the medical business model.

Decisional regret and impacts on quality of life following genitourinary reconstruction for neurogenic bladder: A comparison between acquired and congenital spinal cord injury.

Patient expectations and baseline health are important drivers of outcomes following major genitourinary reconstructive surgery for neurogenic bladder (NGB). Differences in expectations and quality of life (QoL) improvements among different populations with NGB remain insufficiently explored in the literature. To compare decisional regret (DR) and urinary-related QoL (UrQoL) in patients undergoing urinary diversion for NGB arising from spinal cord injury of acquired (A-SCI) and congenital (C-SCI) etiologies. We hypothesize that patients with A-SCI have higher expectations of improvement in QoL following surgery when compared with C-SCI, which may lead to higher DR and decreased UrQoL, postoperatively. In this cross-sectional survey study, we compared A-SCI to C-SCI in terms of DR, UrQoL, and postoperative changes in self-reported physical health, mental health, and pain using validated patient-reported outcome measures. Participants were enrolled from a quaternary care institution via mail and MyChart. The A-SCI group consistied of 17 patients with traumatic spinal cord injury the C-SCI group was composed of 20 patients with spina bifida. Not applicable. The Decisional Regret Scale, Short form- Qualiveen (SF-Qualiveen), and Patient-reported outcomes measurement Information system-10 (PROMIS-10) Global Health surveys. The A-SCI group displayed poorer preoperative physical health than the C-SCI cohort, but absolute postoperative changes in this score, along with mental health score and pain level, were not significant after adjusting for baseline scores and follow-up time. SF-Qualiveen scores revealed significantly worse impact of NGB in UrQoL for A-SCI than for C-SCI when adjusted for other factors. No differences in DR were seen between the groups. Patients with A-SCI demonstrate lower self-reported baseline physical health compared with patients with C-SCI, which may have implications in setting patient expectations when undergoing urinary diversion. In this small cohort, we found a milder self-reported postoperative impact of NGB in UrQoL in patients with C-SCI.

THE IMPORTANCE OF RECONSTRUCTIVE PLASTIC SURGERY IN POST-TRAUMATIC SITUATIONS

Restorative plastic surgery plays a crucial role in restoring form and function to areas of the body affected by trauma. The main aim of this specialty is to improve patients’ quality of life and self-esteem, providing satisfactory aesthetic and functional results. This paper aims to explore and highlight the importance of reconstructive plastic surgery in post-traumatic situations, emphasizing its benefits for patients’ physical and psychological recovery. This is a bibliographic review, using qualitative premises, with the PubMed, Scopus, Web of Science and Scielo databases. To better refine the research, the health descriptors “trauma”, “reconstructive surgery” and “reconstructive plastic surgery after trauma” were used. Restorative plastic surgery is essential for reconstructing areas of the body affected by trauma, such as burns, traumatic wounds, car accidents and firearm injuries. As well as restoring function and aesthetics, these procedures can also improve patients’ quality of life and self-image. Common procedures include soft tissue reconstruction, skin grafts, flaps and reconstructive microsurgery. These techniques allow complex anatomical structures such as bones, muscles, nerves and blood vessels to be restored, re-establishing the functionality and natural appearance of the affected region. As a result, in addition to the physical benefits, reconstructive plastic surgery can also have a significant impact on patients’ mental health. Improved physical appearance can increase self-esteem and confidence, helping with social reintegration and a return to daily activities. It can therefore be concluded that reconstructive plastic surgery plays a vital role in the recovery of patients after trauma, providing not only physical restoration, but also improved quality of life and psychological well-being. It is essential that patients have access to these procedures and that health professionals are aware of their importance in post-traumatic rehabilitation.

Women in Facial Plastic and Reconstructive Surgery: The State of the Academy and Why It Matters.

Facial plastic and reconstructive surgery has historically been a male-dominated field. It is critical to assess the current state of female representation within our Society to better gauge how we reflect the changing needs of our community and our patients. Although we have made headway in fostering a community ripe for progress, we must continue to create and promote equal opportunities, dissuade microaggressions, address burnout, and capitalize on the innate strengths of our female constituents. With the data presented in this study, we hope to further illuminate the benefits of women engagement in our Academy while recommending sustainable actions to create a culture of allyship.

Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis.

Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60Gy RTX were significantly lower than implants receiving < 60Gy (82.8% versus 90.1%, P=0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P=0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P<0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P=0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.

Clinical efficacy and kinematic analysis of Chinese knotting technique-assisted posterior cruciate ligament reconstruction: A retrospective analysis.

To investigate the clinical efficacy and knee joint kinematic changes of posterior cruciate ligament (PCL) reconstruction assisted by Chinese knotting technique (CKT). A retrospective analysis was conducted on 88 cases of PCL reconstructive surgery admitted between September 2016 and September 2020. All patients were operated on by the same senior doctor and his team. The patients were divided into 2 groups according to whether the CKT was applied, with 44 cases in each group. Both groups received active rehabilitation treatment after surgery. All patients were followed up for more than 2 years. International knee documentation committee, hospital for special surgery (HSS), and Lysholm scores were used to evaluate the clinical efficacy of the 2 methods at 3, 12, and 24 months after surgery. The motion cycle and kinematic indices of the knee joint were measured by the Opti_Knee three-dimensional motion measurement system before surgery and at 3, 12, and 24 months after surgery. A secondary arthroscopic examination was performed at 12 months after surgery, MAS score was used to evaluate the secondary endoscopic examination of PCL. All the patients had wound healing in stage I without infection. International Knee in both sets Documentation Committee scores, HSS scores and Lysholm scores were gradually improved at all time points (P < .05); compared with the traditional group, the HSS score was higher in the reduction group 12 months after surgery (P < .05), but there was no significant difference at 24 months after surgery. 12 months and 24 months after 3 dimensional motion measurement system using Opti_Knee showed a reduction group before and after displacement and displacement of upper and lower range than the traditional group (P < 0. 05). One year after surgery, the good and good rate of MAS score reduction group was higher than traditional group. CKT assisted PCL reconstruction can improve the subjective function score of the affected knee joint and the results of secondary microscopy. Satisfactory knee kinematic function can be obtained in the early stage, and the anteroposteric relaxation of the knee joint can be reduced.

Geographic variation in breast reconstruction surgery after mastectomy for females with breast cancer in Alberta, Canada.

Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada. Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction. A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. ≥ 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively. We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents.

Surgical treatment of secondary glaucoma in comorbid pathology with subsequent penetrating keratoplasty (case study)

PURPOSE. To evaluate the effect of surgical treatment of secondary glaucoma with subsequent end-to-end keratoplasty in a patient with aphakia, operated retinal detachment and condition after intrastromal keratoplasty.METHODS. A patient with secondary refractory glaucoma against the background of aphakia, a biopolymer implant in the corneal stroma, an inflammatory reaction to multiple surgical interventions (formation of anterior synechiae), operated retinal detachment was examined in the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" in Moscow. The following treatment was performed: implantation of Ahmed valve drainage and pene-trating keratoplasty with implant removal.RESULTS. On the second day after implantation of Ahmed valve drainage on the right eye, intraocular pressure was normal in palpatory examination, the drainage tube in the anterior chamber was in the correct position. Three months after the operation, there were no complaints, intraocular pressure was normal in palpatory examination, there was a decrease in corneal edema. Penetrating keratoplasty was performed four months after the implantation of Ahmed valve drainage. On the second day after the operation, hypotension was noted with palpatory measurement of intraocular pressure, which persisted for five days. At patient discharge, the graft was adapted, the sutures were consistent, normal pressure with palpatory examination. During the observation period of up to three months, visual acuity increased to 0.1.CONCLUSION. To prolong the hypotensive effect and minimize intra- and postoperative complications in order to achieve the highest possible visual functions before performing optical reconstructive surgery, it is advisable to perform an anti-glaucoma intervention. In secondary refractory glaucoma caused by various factors, the choice of surgical treatment is always individual and depends on the severity of anatomical changes, the experience and capabilities of the surgeon, and often requires multi-stage treatment with continuous observation.

Current trends in retraction of plastic surgery and reconstruction research

Various studies regarding retractions of publications have determined the rate of retraction has increased in recent years. Although this trend may apply to any field, there is a paucity of literature exploring the publication of erroneous studies within plastic and reconstructive surgery. The present study aims to identify trends in frequency and reasons for retraction of plastic and reconstructive surgery studies, with analysis of subspecialty and journals. A database search was conducted for retracted papers within plastic and reconstructive surgery. The initial search yielded 2347 results, which were analyzed by two independent reviewers. 77 studies were jointly identified for data collection. The most common reasons for retractions were duplication (n=20, 25.9%), request of author (n=15, 19.5%), plagiarism (n=9, 11.6%), error (n=9, 11.6%), fraud (n=2, 2.6%), and conflict of interest (n=1, 1.3%). 15 were basic science studies (19.4%), 58 were clinical science studies (75.3%), and 4 were not categorized (5.2%). Subspecialties of retracted papers were maxillofacial (n=29, 37.7%), reconstructive (n=17, 22.0%), wound healing (n=8, 10.4%), burn (n=6, 7.8%), esthetics (n=5, 6.5%), breast (n=3, 3.9%), and trauma (n=1, 1.3%). Mean impact factor was 2.9 and average time from publication to retraction was 32 months. Analysis of retracted plastic surgery studies revealed a recent rise in frequency of retractions, spanning a wide spectrum of journals and subspecialties.

The use of artificial intelligence in reconstructive surgery for head and neck cancer: a systematic review.

The popularity of artificial intelligence (AI) in head and neck cancer (HNC) management is increasing, but postoperative complications remain prevalent and are the main factor that impact prognosis after surgery. Hence, recent studies aim to assess new AI models to evaluate their ability to predict free flap complications more effectively than traditional algorithms. This systematic review aims to summarize current evidence on the utilization of AI models to predict complications following reconstructive surgery for HNC. A combination of MeSH terms and keywords was used to cover the following three subjects: "HNC," "artificial intelligence," and "free flap or reconstructive surgery." The electronic literature search was performed in three relevant databases: Medline (Ovid), Embase (Ovid), and Cochrane. Quality appraisal of the included study was conducted using the TRIPOD Statement. The review included a total of 5 manuscripts (n = 5) for a total of 7524 patients. Across studies, the highest area under the receiver operating characteristic (AUROC) value achieved was 0.824 by the Auto-WEKA model. However, only 20% of reported AUROCs exceeded 0.70. One study concluded that most AI models were comparable or inferior in performance to conventional logistic regression. The highest predictors of complications were flap type, smoking status, tumour location, and age. Some models showed promising results. Predictors identified across studies were different than those found in existing literature, showing the added value of AI models. However, the algorithms showed inconsistent results, underlying the need for better-powered studies with larger databases before clinical implementation.

Infection after Anterior Cruciate Ligament Reconstruction: A Narrative Review of the Literature.

Infection is an uncommon side effect of arthroscopic surgery, and this percentage is higher in anterior cruciate ligament reconstruction (ACLR) surgery, where graft and fixation devices are used. Infections can not only lead to high re-admission rates and poor functional recovery of the knee but can also have a significant negative impact on the patient's psychological and economic health, especially in athletes, as it can affect their sports career. It is important to be aware of the many risk factors, especially the manifestation of symptoms. These may sometimes be non-specific to the infectious pathology and common to other situations, such as the presence of a significant intra-articular hematoma. Septic arthritis after ACLR can occur at any time after surgery but typically presents acutely, while late manifestation is relatively rare. Diagnosis of infection is based on patient history, physical examination, laboratory parameters, and analysis of synovial fluid after joint aspiration, which is the gold standard for diagnosing post-operative infection. Once symptoms appear and the diagnosis seems certain, it is necessary to intervene quickly with arthroscopic debridement and long-term antibiotic treatment to try to save the graft and resolve the infectious situation to avoid graft failure and arthrofibrotic sequelae. The aim of this paper is to provide an overview of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic evaluation, and current treatment guidelines of septic arthritis after ACLR surgery by analyzing recent literature, in particular meta-analyses and systematic reviews.

Functional Exercise Capacity and Perceived Exertion in Patients with Empty Nose Syndrome.

Empty nose syndrome (ENS) is a complex condition characterized by symptoms such as dyspnea, nasal discomfort, and emotional challenges. This study aimed to evaluate functional exercise capacity and perceived exertion in patients with ENS. Patients with ENS who presented with a range of severe symptoms were prospectively enrolled. Pulmonary function was evaluated using spirometry, and functional exercise capacity was measured via the 6 min walk test (6-MWT). Perceived exertion was quantified using the Borg scale, and cardiopulmonary function was evaluated by monitoring peripheral oxygen saturation (SpO2). These parameters were assessed before and after nasal reconstruction surgery. A total of 44 patients with ENS were enrolled and classified into mild-to-moderate (n = 20) and severe (n = 24) symptom groups. Spirometry results showed no significant differences before and after surgery in the entire cohort. Perceived exertion showed significant postoperative improvement (p = 0.006). The severe ENS symptom group experienced significant improvement in SpO2 (p = 0.013) and perceived exertion (p = 0.002) at the end of the 6-MWT after surgery. Surgical intervention significantly enhanced functional exercise capacity (p = 0.038) in patients with mild-to-moderate ENS symptoms. Surgical reconstruction positively affected perceived exertion and SpO2 at the end of the 6-MWT in patients with ENS. The severity of ENS symptoms, as assessed by SNOT-25 scores, influenced these outcomes. These findings underscore the potential benefits of surgical intervention for enhancing exercise tolerance and respiratory efficiency.

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol.

Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma. This will be an international, multicentre audit comparing antimicrobial practices in hand trauma to the standards outlined by WHO. Through the Reconstructive Surgery Trials Network (RSTN), hand surgeons across the globe will be invited to participate in the study. Consultant surgeons/associate specialists managing hand trauma and members of the multidisciplinary team will be identified at participating sites. Teams will be asked to collect data prospectively on a minimum of 20 consecutive patients. The audit will run for eight months. Data collected will include injury details, initial management, hand trauma team management, operation details, postoperative care, and antimicrobial techniques used throughout. Adherence to WHO global guidelines for SSI will be summarized using descriptive statistics across each criteria. The Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) will provide an understanding of the current antimicrobial practice in hand trauma surgery. This will then provide a basis to guide further research in the field. The findings of this study will be disseminated via conference presentations and a peer-reviewed publication.

Executive Summary: Fostering Collaborative Teamwork-A Comprehensive Approach to Vascular Graft Infection Following Arterial Reconstructive Surgery.

Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through multidisciplinary collaboration and discuss decision-making for challenging presentations. This document will concentrate on VGI that impacts both aneurysms and pseudoaneurysms excluding the ascending thoracic aorta.

Advancing Immediate Breast Reconstruction Surgery in Pakistan: Bridging Literature Gaps and Meeting Patient Needs

Breast cancer ranks as the most diagnosed cancer globally and the leading cause of cancer mortality in women, with Pakistan exhibiting a particularly high incidence. However, breast reconstruction surgery, a critical intervention post-mastectomy, remains underutilized in Pakistan due to various barriers. Recent studies shed light on patient perspectives and outcomes regarding immediate breast reconstruction (IBR), indicating its positive impact on psychosocial well-being. Despite these insights, significant literature gaps persist, including the need for comprehensive national data, addressing cultural and awareness barriers, improving access and education, and prioritizing patient-centered care. This short communication underscores the urgency of addressing these gaps to advance breast reconstruction surgery in Pakistan. By conducting comprehensive studies, tackling cultural barriers, and prioritizing patient-centered care, we can ensure improved care and quality of life for Pakistani breast cancer patients. This call to action aims to transform the landscape of breast reconstruction surgery in Pakistan, offering hope for a brighter future for patients.