The role of plastic and reconstructive surgeon in trauma care: Perspectives from a Level 1 trauma centre in India

Considerations on Patients' Quality of Life Following Hand and Forearm Trauma in the Oltenia Region

Hand and forearm trauma is a significant public health concern that has notable physical, psychological, and socioeconomic implications. Understanding the variations in occurrence and characteristics of injuries across different regions is crucial for effective implementation of preventive measures, management strategies, and resource allocation. The study involved 86 cases, with a range of ages from 18 to 70 years old. The participant group consisted of 11 females and 75 males. A series of clinical parameters were analyzed, including gender, age, environment, and cause of trauma. The study requested that participants provide information regarding if they reintegrated into their professional lives and complete the WHOQOL-BREF assessment, which is a tool used to evaluate quality of life. The current investigation has determined that the primary etiologies for hand and forearm injuries are crush and sharp cuts. The results of the investigation indicate a noteworthy association among Age and Cause, Gender and Age, Age and Professional reintegration, as well as between WHOQOL-BREF scores and different parameters. The procurement of epidemiological data plays a crucial role in broadening our comprehension of acute hand and forearm injuries in the Oltenia region.

The use of machine learning for investigating the role of plastic surgeons in anatomical injuries: A retrospective observational study

While plastic surgeons have been historically indispensable in the reconstruction of posttraumatic defects, their role in trauma centers worldwide has not been clearly defined. Therefore, we aimed to investigate the contribution of plastic surgeons in trauma care using machine learning from an anatomic injury viewpoint. We conducted a retrospective study reviewing the data for all trauma patients of our hospital from March 2019 to February 2021. In total, 4809 patients were classified in duplicate according to the 17 trauma-related departments while conducting the initial treatment. We evaluated several covariates, including age, sex, cause of trauma, treatment outcomes, surgical data, and severity indices, such as the Injury Severity Score and Abbreviated Injury Scale (AIS). A random forest algorithm was used to rank the relevance of 17 trauma-related departments in each category for the AIS and outcomes. Additionally, t test and chi-square test were performed to compare two groups, which were based on whether the patients had received initial treatment in the trauma bay from the plastic surgery department (PS group) or not (non-PS group), in each AIS category. The department of PS was ranked first in the face and external categories after analyzing the relevance of the 17 trauma-related departments in six categories of AIS, through the random forest algorithm. Of the 1108 patients in the face category of AIS, the PS group was not correlated with all outcomes, except for the rate of discharge to home (P < .0001). Upon re-verifying the results using random forest, we found that PS did not affect the outcomes. In the external category in AIS, there were 30 patients in the PS group and 56 patients in the non-PS group, and there was no statistically significant difference between the two groups when comparing the outcomes. PS has contributed considerably to the face and external regions among the six AIS categories; however, there was no correlation between plastic surgical treatment and the outcome of trauma patients. We investigated the plastic surgeons' role based on anatomical injury, using machine learning for the first time in the field of trauma care.

Its Not about the Destination, Its about the Journey-Plotting 50 Years of Changing Clinical Trends in Plastic Surgery in a Public Sector Teaching Hospital

Background The year 2019 marked the 50th anniversary of plastic surgery department of our institution. We present an audit to plot the changing clinical trends in our work in the past five decades.

Methods A single-center retrospective cohort study based on the department demographics was performed and compared across the decades from 1969 to 2019.

Results In 1969, the relative proportion of reconstructive versus cosmetic surgery procedures was 94.32% versus 5.68%; in 2019 this was 76.25% and 23.75%, respectively. An increase of 22 times increase in outpatient registrations, 13.1 times in total surgeries, 642 times in trauma reconstruction, 290 times for hand surgeries, and 323 times for skin tumor surgeries was noted. Male patients (64.9%) increased every decade more than females (35.1%), mostly for trauma surgery and gynecomastia correction. Proportion of pediatric cleft patients have markedly decreased. Spectrum of surgical procedures have widened. Top five reconstructive surgeries in 2019 were limb trauma reconstruction, skin tumor surgeries, hand surgeries, arterio-venous fistula (AV) creation, and oculoplasty. The most common surgery performed was cleft lip surgery in 1969 and hand surgery in 2019. The top five cosmetic surgeries performed in 2019 were scar revisions, nevus excision, liposuction and gynecomastia correction, rhinoplasty, and otoplasty.

Conclusions Data collection and archiving and periodic audits help us study changing trends in our field compared with the global trends. Knowing societal demands will help to improve the resident training in teaching hospitals.

Multistep reconstruction of a post-traumatic defect in the lower limb with AV loop and free myocutaneous latissimus dorsi flap combined with a perforator monitor skin island after loss of ALT flap

Crush injuries of the lower extremity with extensive osseous and soft tissue damage impose a big challenge even for an interdisciplinary reconstructive approach. Multistep reconstruction with negative wound pressure therapy for soft tissue management and external fixation for osseous stability preceding free flap transfer leads to optimized outcome. We report the successful multistep reconstruction of a third-degree open right tibial fracture with extensive soft tissue defect with an arteriovenous loop preceding latissimus dorsi flap coverage with a perforator skin island after loss of an anterior lateral thigh (ALT) flap due to intima damage of the recipient vessels. The described method is a safe reconstructive concept after primary flap loss with persistent extensive tissue damage.