1
|
Chang C, Jones C, Berner JE, Ragbir M, Ahmed OA. Beyond Borders: A Global Microsurgery Training and Case Exposure Survey. J Reconstr Microsurg 2024; 40:284-293. [PMID: 37643823 DOI: 10.1055/a-2161-8135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical interventions. Despite anecdotal evidence of varying quality of microsurgery training globally, no empirical studies have investigated this. We conducted a global survey to investigate microsurgical training and clinical case exposure among plastic surgery trainees worldwide. METHODS An online survey was conducted using a secure platform to gather information on microsurgical case exposure and training among plastic surgery trainees between August 2020 and April 2021. Participants provided consent and completed a 37-question survey across four themes: clinical caseload, surgical exposure to microsurgery, microsurgical simulation training exposure, and barriers and opportunities. RESULTS A total of 202 responses were received, with most respondents in formal training programs (86.7%). The data highlighted regional variation in microsurgery case indications and flap types, with North America and Europe exhibiting the highest activity levels in microsurgery. Trainees in Asia have the highest cumulative practical exposure in microsurgery, followed by Australia and Oceania, and North America. Only 39.6% of respondents reported formal microsurgical simulation training, and almost one-third (29.7%) received no simulation training. Trainee access to practical experience is limited by several factors, including insufficient time and procedure complexity. Notably, practical experience was most commonly denied without reason being given. CONCLUSION Our study highlights significant disparities in microsurgical training and exposure among plastic surgery trainees globally. Further research is needed to identify strategies for addressing these issues, given the growing demand for complex reconstructive microsurgery and its impact on health care inequalities.
Collapse
Affiliation(s)
- Chad Chang
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Christopher Jones
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Juan Enrique Berner
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Omar A Ahmed
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
2
|
Kyriazidis I, Spyropoulou GA, Zambacos G, Tagka A, Rakhorst HA, Gasteratos K, Berner JE, Mandrekas A. Adverse Events Associated with Hyaluronic Acid Filler Injection for Non-surgical Facial Aesthetics: A Systematic Review of High Level of Evidence Studies. Aesthetic Plast Surg 2024; 48:719-741. [PMID: 37563436 DOI: 10.1007/s00266-023-03465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Hyaluronic acid (HA) dermal fillers are widely used in aesthetic medicine. While generally safe, potential complications can arise. OBJECTIVE This systematic review aims to identify and classify potential complications linked to the use of HA dermal fillers, as informed by high-quality, low-risk-of-bias studies. METHODS This review follows the Cochrane review standards for clinical systematic reviews. This systematic review analyzed 48 high level of evidence studies on the use of hyaluronic acid (HA) dermal fillers in non-surgical facial aesthetics and the adverse events that occurred.The inclusion criteria were randomized control studies on HA dermal fillers and their complications. Excluded were case reports, case series, observational studies, and other non-randomized research due to their inability to provide generalized conclusions and their inherent publication bias. RESULTS Adverse events were classified into three categories: expected reactions, product or technique-related adverse events, and severe adverse events. Most adverse events were short-lived injection site reactions, which resolved spontaneously. Specific HA fillers and injection techniques influenced the occurrence of adverse events, which generally resolved within weeks without treatment. Severe adverse events were rare, persisting for months and requiring active medical intervention. DISCUSSION This classification system can enhance understanding, prevention, and treatment of HA filler complications, and support patient education. The common complications were injection site reactions, with persistent symptoms treated with topical steroids, NSAIDs, or hyaluronidase. Severe complications included severe edema, angioedema and others, often necessitating specific treatments. CONCLUSION HA dermal fillers are generally safe and effective, with most adverse events being transient and mild to moderate in severity. Severe adverse events, although rare, do occur and are generally non-treatment related. Informed consent, patient education, and professional training are crucial for safe and successful outcomes. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Ioannis Kyriazidis
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403, Thessaloniki, Greece.
| | - Georgia-Alexandra Spyropoulou
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403, Thessaloniki, Greece
| | | | - Anna Tagka
- First Department of Dermatology and Venereology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente/Ziekenhuisgroep Twente, Haaksbergerstraat, Enschede, The Netherlands
| | - Konstantinos Gasteratos
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403, Thessaloniki, Greece
| | - Juan Enrique Berner
- Plastic Surgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | |
Collapse
|
3
|
Chang C, Jones C, Pafitanis G, Berner JE. Here's My QR, So Call Me Maybe: Facilitating Communication in Free Flap Monitoring Using QR Code Printed Dressing. J Reconstr Microsurg 2024; 40:e1-e2. [PMID: 37040874 DOI: 10.1055/a-2071-3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Chad Chang
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Christopher Jones
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Georgios Pafitanis
- Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital. Barts Health NHS Trust, London, United Kingdom
| | - Juan Enrique Berner
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
4
|
Evans J, Chang C, Jones C, Anderson I, Berner JE, Crowley TP, Ragbir M. Clinical characteristics and treatment outcomes of angiosarcoma of the head and neck: A 17-year single-centre experience. J Plast Reconstr Aesthet Surg 2024; 88:452-456. [PMID: 38091688 DOI: 10.1016/j.bjps.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/05/2023] [Accepted: 11/26/2023] [Indexed: 01/02/2024]
Abstract
INTRODUCTION Angiosarcomas in the head and neck region are aggressive tumours associated with high local recurrence and metastatic rates. We present our 17-year experience at the North of England Bone and Soft Tissue Tumour Service. METHODS A retrospective review of our prospectively maintained database was undertaken, looking for patients diagnosed with angiosarcomas affecting the head and neck. Data were gathered using a pre-defined proforma to include demographics, histological characteristics, treatment modalities, adjuvant therapies, local recurrence, distant spread, and disease-specific survival. RESULTS A total of 23 patients (17 males, 6 females) were identified, with a mean age of 76 years at presentation. Fourteen presented with scalp lesions, whereas the remainder arose on the face. Eighteen patients underwent resection with curative intent, whereas three received palliative radiotherapy and two received comfort-based care only. Of the patients undergoing surgery, 12 had local flap reconstruction and 6 underwent free tissue transfer. Clear resection margins were obtained in nine cases (50%). Fourteen patients (78%) presented with local recurrence after surgery, and 11 (61%) developed distant metastases. The median disease-specific survival time for patients treated with curative intent was 38 months. Eight patients had mapping biopsies ahead of their resection; however, complete resection was achieved in only two cases. DISCUSSION Angiosarcomas of the head and neck are associated with a poor prognosis, with most patients rapidly developing local recurrence, resulting in adverse clinical outcomes. Mapping biopsies do not demonstrate a clear advantage for achieving complete surgical resection. A radical surgical approach is warranted, given the aggressiveness of the pathology. However, there remains no consensus on optimal surgical management; we recommend further synthesising studies to determine the most appropriate treatment pathway.
Collapse
Affiliation(s)
- Jonathan Evans
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Chad Chang
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Christopher Jones
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Iain Anderson
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
5
|
Will PA, Kilian K, Bieback K, Fricke F, Berner JE, Kneser U, Hirche C. Lymphedema-associated fibroblasts are a TGF-β1 activated myofibroblast subpopulation related to fibrosis and stage progression in patients and a murine microsurgical model. Plast Reconstr Surg 2023:00006534-990000000-02167. [PMID: 37832143 DOI: 10.1097/prs.0000000000011141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
BACKGROUND The driver of secondary lymphedema (SL) progression is chronic inflammation, which promotes fibrosis. Despite advances in preclinical research, a specific effector cell subpopulation as a biomarker for therapy response or stage progression is still missing for SL. METHODS Whole skin samples of 35 murine subjects of a microsurgical-induced SL model and 12 patients with SL were collected and their fibroblasts were isolated. These lymphedema-derived fibroblasts (LAF) were cultured in a collagen I-poly-D-Lysine 3D hydrogel to mimic skin conditions. Fibroblasts from non-lymphedema skin were used as negative control and TGF-β-stimulated fibroblasts were used to recreate profibrotic myofibroblasts. Quantitative immunocytofluorescence confocal microscopy analysis and invasion functional assays were performed in all subpopulations and statistically compared. RESULTS In contrast to normal skin fibroblasts, LAF exhibit α-SMA-positive stress fibers and a reduced number of tight junctions in 3D hydrogel conditions. The switch from normal E-cadherin high phenotype to an N-cadherin high-E-cadherin low morphology suggests epithelial to mesenchymal transition for expansion and proliferation. This pathological behavior of LAF was confirmed by live cell imaging analysis of invasion assays. The significant activation of markers of the TGFBR2-Smad pathway and collagen synthesis (HSP-47) in LAF supports EMT phenotypic changes and previous findings relating to TGF-β1 and fibrosis with lymphedema. CONCLUSIONS A characteristic SL myofibroblast subpopulation was identified and translationally related to fibrosis and TGF-β1-associated stage progression. This SL-related subpopulation was termed lymphedema-associated fibroblasts. A comprehensive stage-related characterization is required to validate LAF as a reliable biomarker for SL disease progression.
Collapse
Affiliation(s)
- Patrick A Will
- Department of Plastic and Hand Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre BG Klinik Ludwigshafen, Ludwigshafen, Germany
- Plastic Surgery and Hand Surgery, University Heidelberg, Heidelberg, Germany
| | - Katja Kilian
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre BG Klinik Ludwigshafen, Ludwigshafen, Germany
- Plastic Surgery and Hand Surgery, University Heidelberg, Heidelberg, Germany
| | - Karen Bieback
- Institute of Transfusion Medicine and Immunology, Mannheim Institute of Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- FlowCore Mannheim, Medical Faculty Mannheim, Heidelberg University. Mannheim. Germany
- German Red Cross Blood Donor Service Baden-Württemberg - Hessen. Mannheim. Germany
| | - Fabia Fricke
- Applied Tumor Biology,German Cancer Research Center, Heidelberg, Germany
| | - Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, United Kingdom
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre BG Klinik Ludwigshafen, Ludwigshafen, Germany
- Plastic Surgery and Hand Surgery, University Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre BG Klinik Ludwigshafen, Ludwigshafen, Germany
- Plastic Surgery and Hand Surgery, University Heidelberg, Heidelberg, Germany
- Department of Plastic, Hand, and Reconstructive Microsurgery, BG Unfallklinik Frankfurt am Main, Affiliated Hospital of Goethe-University, Frankfurt am Main, Germany
| |
Collapse
|
6
|
Chang C, Ahmed OA, Ragbir M, Berner JE. On the spot: Facilitating visualization of screw placement of bone free flaps in CAD-CAM head and neck reconstruction. Microsurgery 2023; 43:641-642. [PMID: 37349887 DOI: 10.1002/micr.31080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/01/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Chad Chang
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Omar A Ahmed
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Maniram Ragbir
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Juan Enrique Berner
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Kellogg College, University of Oxford, Oxford, UK
| |
Collapse
|
7
|
Berner JE, Teelucksingh S, Saleh DB, Crowley TP, Ragbir M. 'Thou shalt not throw away a living thing': A single-centre 10-year experience using the spare parts principle for complex sarcoma reconstruction. J Plast Reconstr Aesthet Surg 2023; 82:3-11. [PMID: 37148808 DOI: 10.1016/j.bjps.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION For aggressive limb sarcomas beyond reconstructive reach, an amputation may be the only alternative to achieve a complete tumour resection. However, very proximal amputations result in greater loss of function and quality-of-life impact. The spare parts principle advocates utilising tissues distal to the amputation site, for reconstructing complex defects and preserving the function. We aim to present our 10-year experience utilising this principle in complex sarcoma surgery. METHODS A retrospective review of our prospective sarcoma database was conducted for sarcoma patients treated with an amputation between 2012 and 2022. Cases in which distal segments were used for the reconstruction were identified. Demographic data, tumour characteristics, and surgical and non-surgical treatment, along with oncological outcomes and complications, were recorded and analysed. RESULTS Fourteen patients were eligible for inclusion. The median age was 54 years at presentation (8-80 years) with 43% being females. Nine had a primary sarcoma resection, two were treated for recurrent tumours, two presented intractable osteomyelitis following sarcoma treatment and one had an amputation as a palliative procedure. The latter was the only oncological case in which tumour clearance was not achieved. Three patients developed metastasis and subsequently died during follow-up. DISCUSSION Careful balancing of oncological goals and preservation of function is required for proximal limb-threatening sarcomas. When an amputation is required, tissues distal to the cancer site provide a safe reconstructive alternative, optimising patient recovery and preserving function. Our experience is limited by the small number of cases presenting with these rare and aggressive tumours.
Collapse
Affiliation(s)
- Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom.
| | - Sachin Teelucksingh
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Daniel B Saleh
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| |
Collapse
|
8
|
Berner JE, Ali SR, Will PA, Tejos R, Nanchahal J, Jain A. Standardising the management of open extremity fractures: a scoping review of national guidelines. Eur J Orthop Surg Traumatol 2023; 33:1463-1471. [PMID: 35819519 PMCID: PMC10276057 DOI: 10.1007/s00590-022-03324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Open extremity fractures can be life-changing events. Clinical guidelines on the management of these injuries aim to standardise the care of patients by presenting evidence-based recommendations. We performed a scoping systematic review to identify all national clinical practice guidelines published to date. MATERIALS AND METHODS A PRISMA-compliant scoping systematic review was designed to identify all national or federal guidelines for the management of open fractures, with no limitations for language or publication date. EMBASE and MEDLINE database were searched. Article screening and full-text review was performed in a blinded fashion in parallel by two authors. RESULTS Following elimination of duplicates, 376 individual publications were identified and reviewed. In total, 12 clinical guidelines were identified, authored by groups in the UK, USA, the Netherlands, Finland, and Malawi. Two of these focused exclusively on antibiotic prophylaxis and one on combat-related injuries, with the remaining nine presented wide-scope recommendations with significant content overlap. DISCUSSION Clinical practice guidelines serve clinicians in providing evidence-based and cost-effective care. We only identified one open fractures guideline developed in a low- or middle-income country, from Malawi. Even though the development of these guidelines can be time and resource intensive, the benefits may outweigh the costs by standardising the care offered to patients in different healthcare settings. International collaboration may be an alternative for adapting guidelines to match local resources and healthcare systems for use across national borders.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, UK.
- Plastic Surgery Department, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd., E1 1FR, London, UK.
| | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Patrick A Will
- BG Klinik Ludwigshafen, Ludwigshafen Am Rhein, Germany
- Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Rodrigo Tejos
- Sección de Cirugía Plástica y Reconstructiva. Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abhilash Jain
- Imperial College Healthcare NHS Trust, London, UK
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Mughal M, Berner JE, Ho-Asjoe M, See M, Roblin P, Rose V, Mohanna PN. One-stop autologous breast reconstruction: A safe and effective cost-saving pathway. J Plast Reconstr Aesthet Surg 2023; 92:276-281. [PMID: 38582053 DOI: 10.1016/j.bjps.2023.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Patients undergoing autologous breast reconstruction usually require further operations as part of their reconstructive journey. This involves contralateral breast symmetrization and nipple-areola complex (NAC) reconstruction. Restrained access to elective operating space led us to implement a one-stop breast reconstruction pathway. METHODS Patients undergoing contemporaneous contralateral breast symmetrization and immediate NAC reconstruction with free nipple grafts between July 2020 and June 2021 were identified. A retrospective review of our prospectively maintained database was conducted, to retrieve surgical notes, postoperative complications, and length of inpatient stay. A cost analysis was performed considering savings from contralateral symmetrization. RESULTS A total of 50 eligible cases were identified, which had unilateral one-stop breast reconstructions. Complication rates and length of stay were not affected by this approach, with only one free flap being lost for this cohort. This approach resulted in £181,000 being saved for our service over a calendar year. DISCUSSION A one-stop breast reconstruction pathway has proven to be safe and effective in our unit. During these uncertain times, it has streamlined the management of eligible patients, while releasing capacity for other elective operations. Patients avoid having to wait for secondary procedures, finishing their reconstructive pathway earlier. We plan to continue providing this service which has shown to be beneficial clinically and financially.
Collapse
Affiliation(s)
- Maleeha Mughal
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom.
| | - Juan Enrique Berner
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mark Ho-Asjoe
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Marlene See
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Paul Roblin
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Victoria Rose
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Pari-Naz Mohanna
- Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| |
Collapse
|
10
|
Berner JE, Pafitanis G, Nikkhah D, Crowley TP, Ragbir M. Tips and Tricks for Navigating the Microvascular Coupler Anastomosis Learning Curve. Arch Plast Surg 2023. [DOI: 10.1055/s-0042-1760294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Juan Enrique Berner
- Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Georgios Pafitanis
- Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Dariush Nikkhah
- Plastic Surgery Department, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Timothy P. Crowley
- Plastic Surgery Department, Royal Victoria Infirmary and Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Maniram Ragbir
- Plastic Surgery Department, Royal Victoria Infirmary and Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| |
Collapse
|
11
|
Berner JE, Pafitanis G, Nikkhah D, Crowley TP, Ragbir M. Tips and tricks for navigating the microvascular coupler anastomosis learning curve. Arch Plast Surg 2022; 50:213-215. [PMID: 36999156 PMCID: PMC10049803 DOI: 10.1055/a-1988-3066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022] Open
Abstract
Not applicable
Collapse
Affiliation(s)
- Juan Enrique Berner
- Platic Surgery Department, The Royal London Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Georgios Pafitanis
- Platic Surgery Department, The Royal London Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Dariush Nikkhah
- Plastic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Timothy P. Crowley
- Plastic Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Maniram Ragbir
- Plastic Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
12
|
Citron I, Thomson D, Pescarini E, Creasy H, Sorooshian P, Berner JE, Neville C, Kannan RY, Nduka C. Descriptive Study of Facial Motor Cocontractions During Voluntary Facial Movement in a Healthy Population: A New Hypothesis Contributing to Synkinesis. Facial Plast Surg Aesthet Med 2022; 25:244-249. [PMID: 36083281 DOI: 10.1089/fpsam.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Motor overflow refers to involuntary movements that accompany voluntary movements in healthy individuals. This may have a role in synkinesis. Objective: To describe the frequency and magnitude of facial motor overflow in a healthy population. Methodology: Healthy participants performed unilateral facial movements: brow elevation, wink, snarl, and closed smile. Two reviewers analyzed the magnitude of each movement and cocontraction. Patterns of movements are described. Univariate analysis was used to assess the relationship between efficacy of unilateral facial control and the frequency and magnitude of cocontractions. Results: Eighty-nine participants completed the videos. Consensual mirror movements occurred in 96% of participants during unilateral eye closure and 86% during brow elevation. The most common associated movement was ipsilateral eye constriction occurring during snarl (90.1%). Improved unilateral facial control was associated with a decrease in frequency and magnitude of associated movements during brow elevation, wink, and snarl. Conclusion: This study showed stereotyped patterns of motor overflow in facial muscles that resemble those in synkinesis and become more evident as unilateral control of the face decreases.
Collapse
Affiliation(s)
- Isabelle Citron
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - David Thomson
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Elena Pescarini
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - Henrietta Creasy
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Parviz Sorooshian
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | | | - Catriona Neville
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Ruben Y Kannan
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Charles Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| |
Collapse
|
13
|
Fernandez-Diaz OF, Navia A, Berner JE, Ahmad F, Guerra C, Ragbir M. Watch One, Do One? A Systematic Review and Educational Analysis of YouTube Microsurgery Videos, and a Proposal for a Quality Assurance Checklist. Arch Plast Surg 2022; 49:668-675. [PMID: 36159366 PMCID: PMC9507557 DOI: 10.1055/s-0042-1756349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background
Educational resources on the internet are extensively used to obtain medical information. YouTube is the most accessed video platform containing information to enhance the learning experience of medical professionals. This study systematically analyzed the educational value of microsurgery-related videos on this platform.
Methods
A systematic review was conducted on YouTube from April 18 to May 18, 2020, using the following terms: “microsurgery,” “microsurgical,” “microsurgical anastomosis,” “free flap,” and “free tissue transfer.” The search was limited to the first 100 videos, and two independent reviewers screened for eligible entries and analyzed their educational value using validated scales, including a modified version of the DISCERN score (M-DISCERN),
Journal of the American Medical Association
(JAMAS) benchmark criteria, and the Global Quality Score (GQS). Evaluation of video popularity was also assessed with the video power index (VPI).
Results
Of 356 retrieved videos, 75 (21%) were considered eligible. The educational quality of videos was highly variable, and the mean global scores for the M-DISCERN, JAMAS, and GQS for our sample were consistent with medium to low quality.
Conclusions
A limited number of videos on YouTube for microsurgical education have high-educational quality. The majority scored low on the utilized criteria. Peer-reviewed resources seem to be a more reliable resource. Although the potential of YouTube should not be disregarded, videos should be carefully appraised before being used as an educational resource.
Collapse
Affiliation(s)
- Oscar F Fernandez-Diaz
- St. Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital. Chelmsford, United Kingdom.,Group for Academic Plastic Surgery, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Alfonso Navia
- Plastic and Reconstructive Surgery Section, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, United Kingdom.,Plastic Surgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Fateh Ahmad
- St. Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital. Chelmsford, United Kingdom
| | - Claudio Guerra
- Plastic and Reconstructive Surgery Section, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Maniram Ragbir
- Plastic Surgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
14
|
Berner JE, Chan JKK, Gardiner MD, Navia A, Tejos R, Ortiz-Llorens M, Ortega-Briones A, Rakhorst HA, Nanchahal J, Jain A. International Lower Limb Collaborative (INTELLECT) study: a multicentre, international retrospective audit of lower extremity open fractures. Br J Surg 2022; 109:792-795. [PMID: 35470389 PMCID: PMC10364752 DOI: 10.1093/bjs/znac105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 08/02/2023]
Abstract
Sixty-two centres in 16 countries contributed with 2,694 open fractures cases to an international, multi-centric, retrospective cohort study involving different healthcare settings. The INTELLECT study results show that there are significant disparities on the management of open lower limb fractures internationally. A timely, multidisciplinary, guideline-directed care is a protective factor for developing infective complications, non-union and requiring an amputation.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Correspondence to: Juan Enrique Berner, Department of Plastic Surgery, Royal London Hospital, Whitechapel Road, London E1 1FR, UK (e-mail: )
| | - James K K Chan
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Slough, UK
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alfonso Navia
- Sección de Cirugía Plástica y Reconstructiva, División de Cirugía. Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Tejos
- Sección de Cirugía Plástica y Reconstructiva, División de Cirugía. Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Alina Ortega-Briones
- Trauma and Orthopaedic Surgery Department, Hospital San José Quirónsalud, Madrid, Spain
| | - Hinne A Rakhorst
- Plastic and Reconstructive Surgery Department, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jagdeep Nanchahal
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
15
|
Hijazi Y, Elbaz A, Mutsago T, Bystrzonowski N, Berner JE, Pafitanis G. Fasciocutaneous perforator flap direct monitoring with a smartphone instant heart rate app. Microsurgery 2022; 42:522-523. [PMID: 35611642 DOI: 10.1002/micr.30922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/06/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Yasser Hijazi
- London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ahmed Elbaz
- London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tonderai Mutsago
- London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nicola Bystrzonowski
- London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Juan Enrique Berner
- London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Georgios Pafitanis
- London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
16
|
Will PA, Wan Z, Seide SE, Berner JE, Kneser U, Gazyakan E, Hirche C. Supermicrosurgical treatment for lymphedema: a systematic review and network meta-analysis protocol. Syst Rev 2022; 11:18. [PMID: 35105375 PMCID: PMC8805248 DOI: 10.1186/s13643-022-01885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 01/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lymphedema is a condition that affects up to 130 million subjects worldwide. Since it is related to several complications and a significant reduction in terms of quality of life, it is a heavy burden not only to the patients but also for the healthcare system worldwide. Despite the development of supermicrosurgery, such as vascularized lymph node transfer (VLNT) and lymphovenous anastomosis LVA, the indications and outcomes of these complex groups of interventions remain a controversial topic in the field of reconstructive plastic surgery. METHODS This systematic review and network meta-analysis aims to assess the evidence of outcomes of LVA and VLNT in patients with lymphedema. Secondary aims of the project are to determine if for any outcomes, LVA or VLNT is superior to conservative therapy alone, and whether the available evidence favors any kind of supermicrosurgical interventions for lymphedema patients. This study will include original studies of patients with lymphedema on the extremities indexed in PubMed, EMBASE, CENTRAL, PASCAL, FRANCIS, ISTEX, LILACS, CNKI, and IndMED that reported microsurgery (supermicrosurgery) of all techniques aiming the re-functionalization of the lymphatic system. As comparators, mere observation, conservative treatment of any kind, and the other subgroups of supermicrosurgery are planned. The primary outcome of this systematic review and network meta-analysis is the difference of the limb volume, while the secondary outcomes of interest will be erysipelas rates, major and minor complications, postoperative necessity of continuous compression garments, and patient satisfaction, measured by already published and validated scores for quality of life. DISCUSSION We will provide an overview and evidence grade analysis of the scientific literature available on the effectiveness of the subcategories of supermicrosurgical interventions for lymphedema.
Collapse
Affiliation(s)
- Patrick A Will
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Center Ludwigshafen, Ludwig Guttmann Str. 13, 67071, Ludwigshafen am Rhein, Germany.
- Medical Faculty of the University Heidelberg, Heidelberg, Germany.
| | - Zhenzhen Wan
- Medical Faculty of the University Heidelberg, Heidelberg, Germany
| | - Svenja E Seide
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, UK
- Department of Plastic Surgery, The Royal London Hospital, London, UK
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Center Ludwigshafen, Ludwig Guttmann Str. 13, 67071, Ludwigshafen am Rhein, Germany
- Medical Faculty of the University Heidelberg, Heidelberg, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Center Ludwigshafen, Ludwig Guttmann Str. 13, 67071, Ludwigshafen am Rhein, Germany
- Medical Faculty of the University Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Plastic, Hand, and Reconstructive Microsurgery, BG-Trauma Hospital Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
17
|
Navia A, Berner JE, Ramirez J, Will P, Tejos R, Dagnino B, Searle S, Cuadra A. Evaluation of Research Opportunities and Limitations for Plastic Surgery Residents: An International Survey. Ann Plast Surg 2021; 87:488-492. [PMID: 33833167 DOI: 10.1097/sap.0000000000002839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conducting research during specialty training provides an opportunity to develop critical thinking and leadership skills along with a better understanding of the scientific literature. However, trainees often find it difficult to undertake research, in the context of labor-intensive surgical training. The aim of this study is to evaluate the research output and limitations of plastic surgery residents in different countries. METHODS An international cross-sectional study involving plastic surgery trainees and recent postgraduates from Brazil, Chile, Germany, and the United Kingdom was conducted. A survey inquiring into academic productivity, limitations to conducting research, and working-hours patterns was distributed among eligible participants. RESULTS From September to December 2019, 106 surveys were retrieved. Most respondents declared having participated in at least 1 project that resulted in a presentation or publication during their training (90.6% in national presentations, 68% international presentations, 67% in national publications, and 66% international publications). Having completed a previous research fellowship was associated with a statistically higher academic output (P < 0.05). Seventy-nine percent of respondents felt that their participation in research activities would have been greater if limiting factors had been addressed, including lack of time (72.5%) and insufficient supervision and mentoring (55%). CONCLUSIONS Optimizing plastic surgery trainees' participation in scientific research is beneficial both for residents and their mentors. Research fellowships can provide an opportunity for academically oriented trainees to further develop their research skills. Protected time and adequate mentoring can help not only to increase residents' research output, but also to recruit the next generation of academic plastic surgeons.
Collapse
Affiliation(s)
- Alfonso Navia
- From the Plastic and Reconstructive Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Enrique Berner
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Patrick Will
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen- Heidelberg University, Ludwigshafen, Germany
| | - Rodrigo Tejos
- From the Plastic and Reconstructive Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Dagnino
- From the Plastic and Reconstructive Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susana Searle
- From the Plastic and Reconstructive Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro Cuadra
- From the Plastic and Reconstructive Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
18
|
Berner JE, Mughal M, Mohanna PN, Kothari A, Hamed H, See M, Ho-Asjoe M, Roblin P, Rose V. Free nipple grafts for immediate autologous breast reconstruction: Expediting the reconstructive journey. J Plast Reconstr Aesthet Surg 2021; 74:3443-3476. [PMID: 34697003 DOI: 10.1016/j.bjps.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Juan Enrique Berner
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Maleeha Mughal
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom.
| | - Pari-Naz Mohanna
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Ashutosh Kothari
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Hisham Hamed
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Marlene See
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Mark Ho-Asjoe
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Paul Roblin
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Victoria Rose
- Guy's and St Thomas' Hospital, NHS Foundation Trust, Westminster Bridge Rd, London SE17EH, United Kingdom
| |
Collapse
|
19
|
Verheul E, Berner JE, Oflazoglu K, Troisi L, Arnež Z, Ortega-Briones A, Nanchahal J, Rakhorst H. Development of guidelines for the management of patients with open fractures: The potential cost-savings of international collaboration. J Plast Reconstr Aesthet Surg 2021; 75:439-488. [PMID: 34690093 DOI: 10.1016/j.bjps.2021.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/29/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Elfi Verheul
- Department of Plastic Surgery, Medisch Spectrum Twente. Enschede, the Netherlands.
| | - Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, United Kingdom; Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Kamilcan Oflazoglu
- Department of Plastic Surgery, VU Medisch Centrum, Amsterdam, the Netherlands
| | - Luigi Troisi
- University Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy
| | - Zoran Arnež
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste, Italy; Plastic Reconstructive and Aesthetic Surgery Department, Ospedale di Cattinara, ASUITs, Trieste, Italy
| | - Alina Ortega-Briones
- Trauma and Orthopaedic Surgery Department, Hospital San José Quirónsalud, Madrid, Spain
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Hinne Rakhorst
- Department of Plastic Surgery, Medisch Spectrum Twente. Enschede, the Netherlands
| |
Collapse
|
20
|
Berner JE, Geoghegan L, Kyriazidis I, Nanchahal J, Jain A. Alternative physical treatments for deep venous thrombosis prophylaxis in surgical patients: a systematic review. Physiotherapy 2021; 113:73-79. [PMID: 34562667 DOI: 10.1016/j.physio.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) represents a major cause of morbidity and mortality. A variety of novel physical therapies have been proposed for patients in whom standard prophylaxis, including early mobilisation, is contraindicated. This article presents a systematic literature review of alternative physical treatments for VTE prophylaxis, focusing on surgical and trauma patients. METHODS Following protocol registration in PROSPERO, a systematic review was conducted in accordance with PRISMA. MEDLINE and EMBASE databases were searched for all studies indexed before 27th of July 2019. Two authors independently screened these articles. Data gathering for eligible articles was also undertaken in parallel by two authors. A formal risk of bias assessment was conducted for each study along with an assessment on the quality of the evidence using the GRADE framework. RESULTS A total of 272 abstracts were identified. After exclusion of duplicates and non-eligible articles, 10 publications were reviewed in detail. Two studies involving electrostimulation, another using a portable intermittent compression device and one study using postoperative calf massage reported a statistically significant reduction in the incidence of deep venous thrombosis when used in conjunction with LMWH. The remaining six articles did not show any significant benefits. DISCUSSION All studies reporting significant benefits have methodological flaws, with a high risk of bias. The evidence base informing alternative physical treatments as prophylactic measures in VTE is limited. Our data suggest that the use of these physical modalities can be beneficial in patients who also received LMWH, whilst these alone are of no benefit. LEVEL OF EVIDENCE II - Systematic Review Systematic Review Registration Number PROSPERO CRD42019133684.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, United Kingdom; Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Luke Geoghegan
- Imperial College NHS Trust, London, United Kingdom; Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | | | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Abhilash Jain
- Imperial College NHS Trust, London, United Kingdom; Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
21
|
Berner JE, Chan JKK, Gardiner MD, Rakhorst H, Ortega-Briones A, Nanchahal J, Jain A. Standards for treatment of open lower limb fractures maintained in spite of the COVID-19 pandemic: Results from an international, multi-centric, retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74:1633-1701. [PMID: 33386269 PMCID: PMC7832949 DOI: 10.1016/j.bjps.2020.12.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Juan Enrique Berner
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Rd., Newcastle upon Tyne, NE1 4LP, United Kingdom,Kellogg College, University of Oxford, 60-62 Banbury Rd, Oxford, OX2 6PN, United Kingdom
| | - James K.-K. Chan
- Department of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL, United Kingdom,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, United Kingdom
| | - Matthew D. Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Slough, SL2 4HL, United Kingdom,The Kennedy Institute of Rheumatology. Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford. Oxford, OX3 7FY, United Kingdom
| | - Hinne Rakhorst
- Plastic and Reconstructive Surgery Department, Medisch Spectrum Twente, Enschede, Netherlands
| | - Alina Ortega-Briones
- Trauma and Orthopaedic Surgery Department, Hospital San José Quirónsalud, Madrid, Spain
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology. Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford. Oxford, OX3 7FY, United Kingdom
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, United Kingdom
| | | |
Collapse
|
22
|
Berner JE, Crowley TP, Teelucksingh S, Lee D, Ghosh KM, Beckingsale TB, Rankin KS, Ragbir M. The importance of clear margins in myxofibrosarcoma: Improving local control by means of staged resection and reconstruction. Eur J Surg Oncol 2021; 47:2627-2632. [PMID: 34167854 DOI: 10.1016/j.ejso.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Myxofibrosarcomas are associated with a locally infiltrative growth pattern, making a clear-margin resection margin challenging. This leads to high local recurrence rates. While immediate wound closure and adjuvant radiotherapy has been proposed to mitigate incomplete excisions, we present our experience treating myxofibrosarcomas with staged excisions until clear margins are obtained, prior to reconstruction. METHODS All patients with myxofibrosarcomas treated with a curative intent at our centre between 2009 and 2019 were identified. Patient demographics, tumour characteristics, number of resections, method of reconstruction, adjuvant therapy, complications, local recurrence rates, length of hospital stay and overall survival were assessed. RESULTS 97 consecutive eligible patients were identified. Forty-six (47%) had positive margins reported following a first resection. The median number of resections required to obtain clear margins was two and the median time from first excision to definitive wound closure was 15 days. Local recurrence rate for the whole cohort was 14%. Patients who had staged resection until clear margins were obtained had a significantly lower rate of local recurrence compared to those who had positive margins at time of reconstruction (p-value = 0.001). The estimated 5-year disease-specific survival for the whole cohort was 93%. DISCUSSION Obtaining clear margins in myxofibrosarcoma via staged resections was associated with lower local recurrence rates for patients who had an initial resection with positive margins. The outcomes of performing staged resections are equivalent to patients for whom a clear margin were obtained in the first instance.
Collapse
Affiliation(s)
- Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom; Kellogg College, University of Oxford. Oxford, United Kingdom.
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Sachin Teelucksingh
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Daniela Lee
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Kanishka M Ghosh
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Thomas B Beckingsale
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Kenneth S Rankin
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| |
Collapse
|
23
|
Berner JE, Magdum A. The Newcastle Microsurgery Fellowship: A Truly Multidisciplinary Training Experience. Ann Plast Surg 2021; 86:499-500. [PMID: 33346548 DOI: 10.1097/sap.0000000000002665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The Newcastle upon Tyne Hospitals NHS Foundation Trust Plastic Surgery Department offers a 12-month, intense and comprehensive fellowship covering almost every aspect of reconstructive microsurgery. Across its 2 sites at The Royal Victoria Infirmary and Freeman Hospital, over 175 free flaps are performed every year, spanning the breadth of head and neck oncology, sarcoma, facial palsy, and breast and limb reconstruction. The appointed fellow is expected to be involved in at least 90 microsurgical cases, plus a reasonable number of complex nonfree flap reconstructions. An overview of this hands-on microsurgery fellowship is hereby presented based on the experience of 2 recent fellows.
Collapse
Affiliation(s)
- Juan Enrique Berner
- From the Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust. Newcastle upon Tyne
| | - Ashish Magdum
- Department of Plastic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust. Sheffield, United Kingdom
| |
Collapse
|
24
|
Khoury A, Dawood O, Troisi L, Pajardi G, Blackburn A, Berner JE, Teo TC. Reducing risk to perineal propeller flaps from adverse positional change: a novel application of near-infrared spectroscopy tissue monitoring technology. Eur J Plast Surg 2021. [DOI: 10.1007/s00238-021-01797-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
Berner JE, Dearden A, Magdum AA, Crowley TP, Rankin K, Clarke MJ, Ragbir M. Safety of limb-salvaging surgery for sarcomas compromising major vessels: A 15-year single-centre outcomes study. J Plast Reconstr Aesthet Surg 2021; 74:2076-2084. [PMID: 33549508 DOI: 10.1016/j.bjps.2020.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Limb-threatening sarcomas invading major vessels present an oncological and reconstructive challenge. Curative resection involves either performing an amputation or an immediate reconstruction of the invaded vessels. We present our 15-year experience of these cases at the North of England Bone and Soft Tissue Tumour Service. MATERIALS AND METHODS A Strengthening the Reporting of Observational studies in Epidemiology (STROBE) compliant retrospective review of our prospective database was performed including patients who required major vessel reconstruction following sarcoma excision from 2003 until 2018. Patient demographic data along with tumour and histological subtypes, treatment modality, complications and outcomes were inquired. Autologous and prosthetic vessel reconstruction approaches were compared. RESULTS Nineteen patients were identified with the most common tumour locations being the thigh and groin areas. Five cases involved recurrent tumours. Clear resection margins were obtained in 15 cases. Autologous vein grafts were preferred over polytetrafluoroethylene (PTFE) prosthesis in 17 cases. A pedicled flap or free flap was required to achieve adequate soft tissue cover in six patients, while the rest underwent primary closure. Five patients lost the patency of the reconstructed vessels with one of these requiring an amputation. The estimated disease-specific survival at 5 years was 58%. DISCUSSION Limb-preservation surgery in the context of vessel compromise is not only safe, but also a functionally and psychosocially beneficial means of avoiding an amputation. We believe that careful pre-operative planning and discussion in a multidisciplinary setting is key for obtaining positive outcomes.
Collapse
Affiliation(s)
- Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Kellogg College, University of Oxford, Oxford, United Kingdom.
| | - Alexander Dearden
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ashish A Magdum
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Kenneth Rankin
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michael J Clarke
- Department of Vascular Surgery, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
26
|
Marlborough F, Berner JE, Ahmed OA, Ragbir M. Comment on Assessing the Influence of Attending Surgeon Continuity on Free Flap Outcomes Following Unplanned Returns to the Operating Room. J Reconstr Microsurg 2020; 36:e1-e2. [PMID: 33231271 DOI: 10.1055/s-0040-1721121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Fergal Marlborough
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Juan Enrique Berner
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Omar A Ahmed
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
27
|
Christopoulos G, Berner JE, Sergentanis TN, Blackburn A, Mackey SP. The use of bi-pedicled DIEP flap for unilateral breast reconstruction: a 5-year retrospective study. Eur J Plast Surg 2020. [DOI: 10.1007/s00238-020-01742-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
28
|
Affiliation(s)
- Alfonso Navia
- Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Corresponding Author: Dr Alfonso Navia, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago 8330024, Chile. E-mail: ; Instagram: @ajnavia17
| | - Juan Enrique Berner
- Plastic Surgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Nicolas Pereira
- Clínica Las Condes and Hospital del Trabajador, Santiago, Chile
| | - Dimitris Reissis
- Plastic Surgery Department, Royal Free Hospital, London, United Kingdom
| | - Hinne Rakhorst
- Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Alvaro Cuadra
- Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
29
|
Narayan N, Berner JE, Saeed A, Zanchetta F, Troisi L. Outcomes of the Pedicled Medial Sural Artery Perforator Flap for Soft Tissue Reconstruction Around the Knee: When to Use It and How to Look After It. J Hand Microsurg 2020; 14:216-221. [DOI: 10.1055/s-0040-1715919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg defects due to its reliability and simplicity to raise. However, it has the disadvantage of being bulky, requiring a skin graft for coverage, and is associated with loss of muscle power. The pedicled medial sural artery perforator (MSAP) flap has gained popularity as a reconstructive alternative for defects of the lower extremities. We present a case series of pedicled MSAP flaps for reconstructing defects around the knee as an alternative to the medial gastrocnemius flap.
Materials and Methods A consecutive series of patients with proximal leg defects following trauma, osteomyelitis, burns, and chronic wounds were included. A hand-held Doppler was used to map out the MSAPs. Defects were reconstructed using pedicled MSAP flaps, preserving the nerve supply to the gastrocnemius muscle. Patient outcomes were recorded, including their Enneking scores postreconstruction.
Results A total of 10 pedicled flaps was performed to reconstruct defects around the knee joint between October 2017 and November 2018. All the patients were discharged 1 week postoperatively, and rehabilitation consisted of graduated flexion in a knee brace by means of controlled passive mobilization. Three out of the ten patients developed complications: one patient developed flap congestion, one developed epidermolysis of the tip of the flap, and the other patient had partial necrosis of the skin paddle. The average Enneking score was 29 out of 35.
Conclusion The pedicled MSAP flap is a good reconstructive option for proximal leg defects as it is associated with lower donor site morbidity and provides an aesthetically pleasing reconstruction.
Collapse
Affiliation(s)
- Nitisha Narayan
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - Juan Enrique Berner
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Ayman Saeed
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Francesco Zanchetta
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
- Reconstructive Microsurgery Service, University Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy
- Plastic Reconstructive and Aesthetic Surgery Unit, University of Messina, Policlinico “G. Martino,” Messina, Italy
| | - Luigi Troisi
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
- Reconstructive Microsurgery Service, University Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy
| |
Collapse
|
30
|
Berner JE, Will P, Geoghegan L, Troisi L, Nanchahal J, Jain A. Safety and effectiveness of early compression of free flaps following lower limb reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2020; 73:1604-1611. [PMID: 32563669 DOI: 10.1016/j.bjps.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Early postoperative compression of free flaps for lower limb reconstruction remains controversial. It may reduce venous congestion and promote the resolution of oedema. However, concerns remain regarding inadvertent pedicle compression, which may lead to flap failure. The aim of this systematic review was to determine the safety and effectiveness of this intervention. METHODS A systematic review was designed in compliance with PRISMA. MEDLINE and EMBASE databases were searched. Parallel screening, selection of eligible studies, and data gathering were carried out by two independent authors. A formal risk of bias assessment was included along with the appraisal of outcomes. RESULTS A total of 847 abstracts were retrieved and 262 free flaps for lower limb reconstruction were identified in ten eligible articles. The overall flap failure rate for patients who underwent early postoperative compression was 1.6%. Apart from flap failure rates, there were no other outcomes consistently reported and none of the studies included a no-compression group for comparison. DISCUSSION All included studies had methodological flaws, resulting in a high risk of bias. Nevertheless, there was consistent reporting of flap failure as a postoperative outcome. Compression of free flaps in the context of lower limb reconstruction does not appear to be associated with a higher flap failure rate compared with other series. Compression bandages may reduce the pain associated with dangling regimes. However, there is no evidence to support that free flap compression in the context of lower limb reconstruction is associated with any other clinical benefit.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital, NHS Foundation Trust, East Grinstead, United Kingdom; Kellogg College, University of Oxford, Oxford OX2 6PN, United Kingdom.
| | - Patrick Will
- BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; Ruprecht Karl, University of Heidelberg, Heidelberg, Germany
| | - Luke Geoghegan
- Imperial College Healthcare, NHS Trust, London, United Kingdom
| | - Luigi Troisi
- University Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology. Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Abhilash Jain
- Imperial College Healthcare, NHS Trust, London, United Kingdom; Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
31
|
Abstract
AbstractA variety of free tissue flaps have been described for autologous breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is most microsurgeons’ first choice, there is no consensus regarding which is the second-best alternative. The transverse upper gracilis (TUG) flap has gained popularity for cases where the abdomen is not a suitable donor site. This musculocutaneous flap has the advantage of an easy dissection, allowing the harvest of tissue from the medial thigh area with the patient supine. However, drawbacks include a tedious donor site closure and a limited amount of soft tissue that can be transferred. The authors hereby present a modification of the TUG flap, introducing an L-shaped skin paddle: the L-shaped upper gracilis (LUG) flap. This alternative allows harvesting extra tissue from the medial thigh, while providing an easier donor site closure with the patient supine. A prospective case series of 14 LUG flaps is presented. No flap failures or episodes of fat necrosis were encountered; only one developed a donor site seroma that settled after drainage. The LUG flap is a useful development of the TUG flap concept providing up to 50% more tissue than a standard TUG flap with an aesthetically pleasing donor site closure which is useful for cases in which abdominal flaps are not possible.Level of evidence: Level IV, therapeutic study.
Collapse
|
32
|
Berner JE, Pickford M. Double Fillet Flaps from a Single Digit for Adjacent Finger Salvage. J Hand Microsurg 2020; 12:67-68. [DOI: 10.1055/s-0039-1688682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Mark Pickford
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| |
Collapse
|
33
|
Berner JE, Al-Aswad F, Mistry R, Pickford M. Distal skeletal traction with a temporary Kirschner wire to facilitate open reduction and internal fixation of phalangeal fractures. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32111575 DOI: 10.1016/j.bjps.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust. Plastic Surgery Department. Holtye Road, East Grinstead. RH19 3DZ, United Kingdom; Kellogg College, University of Oxford. 60-62 Banbury Road. Oxford. OX2 6PN, United Kingdom.
| | - Firas Al-Aswad
- Queen Victoria Hospital NHS Foundation Trust. Plastic Surgery Department. Holtye Road, East Grinstead. RH19 3DZ, United Kingdom
| | - Rikki Mistry
- Queen Victoria Hospital NHS Foundation Trust. Plastic Surgery Department. Holtye Road, East Grinstead. RH19 3DZ, United Kingdom
| | - Mark Pickford
- Queen Victoria Hospital NHS Foundation Trust. Plastic Surgery Department. Holtye Road, East Grinstead. RH19 3DZ, United Kingdom
| |
Collapse
|
34
|
Berner JE, Magdum A, Blackburn A. Simultaneous bi-pedicled DIEP and TUG flaps to enhance cosmetic outcome in unilateral delayed breast reconstruction: two flaps with three pedicles for one breast. Eur J Plast Surg 2020. [DOI: 10.1007/s00238-020-01627-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractAutologous breast reconstruction using free tissue transfer allows ‘like-for-like’ restoration of skin and volume following a mastectomy. Even though the majority of patients will require only one flap to restore their anatomy, occasionally, more than one flap is needed to get the best possible cosmetic outcome. For reconstructing the breast of a slim 49-year-old female patient, a bi-pedicled deep inferior epigastric perforator flap was used to replace the missing skin envelope, in combination with a buried transverse upper gracilis flap for volume restoration. The internal mammary vessels between the second and fourth costal cartilages were used as sole vessel recipient site, by preserving their intercostal perforators. Postoperative recovery was uneventful, and the patient was discharged 2 days after her operation. This case shows how a bi-pedicled DIEP with a TUG flap can be used for the challenging scenario in which reconstructive and cosmetic goals are equally important.Level of evidence: Level V, therapeutic study.
Collapse
|
35
|
Nikkhah D, Berner JE, Pickford M. Use of cannulated compression screws for skeletal stabilisation during digital re-vascularisation. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32008942 DOI: 10.1016/j.bjps.2020.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Dariush Nikkhah
- Consultant Plastic Surgeon FRCS Plast, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG, United Kingdom.
| | - Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Mark Pickford
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| |
Collapse
|
36
|
|
37
|
Moller L, Berner JE, Dheansa B. The reconstructive journey: Description of the breast reconstruction pathway in a high-volume UK-based microsurgical centre. J Plast Reconstr Aesthet Surg 2019; 72:1930-1935. [DOI: 10.1016/j.bjps.2019.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/19/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
|
38
|
Berner JE, Nikkhah D, Zhao J, Prousskaia E, Teo TC. The Versatility of the Superficial Circumflex Iliac Artery Perforator Flap: A Single Surgeon's 16-Year Experience for Limb Reconstruction and a Systematic Review. J Reconstr Microsurg 2019; 36:93-103. [PMID: 31476772 DOI: 10.1055/s-0039-1695051] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The superficial circumflex iliac artery perforator (SCIP) flap is a versatile option of free tissue transfer for small to large defects. In this study, we examine the advantages of the SCIP flap, its cadaveric anatomy, and clinical subtypes. METHODS Ten cadavers were dissected and the corresponding pedicles of the SCIP and groin flaps were identified. A retrospective review of 20 clinical cases of free SCIP flap reconstruction was undertaken. The indication for reconstruction, flap dimensions, and survival were analyzed. A systematic literature review was conducted including articles that have previously reported the use of the SCIP flap. RESULTS The SCIP pedicle was present in all our cadaveric dissections. The starting point of its pedicle ranged from 1.5 to 4.5 cm along the superficial circumflex iliac artery. The median diameter of the perforator and its concomitant vein was 1mm (range 0.8-2 mm). A cutaneous vein (1.3-2.3 mm) could be included in the flap if the concomitant vein was too small. Twenty consecutive patients had free SCIP flaps between 2002 and 2018. The indications were for finger defects (n = 8), thumb reconstruction (n = 1), lower limb compound fractures (n = 3), iatrogenic wounds (n = 2), upper limb large defects (n = 2), and scar contractures (n = 4). Flap dimensions ranged from 2 × 4 cm to 14 × 25cm, and the longest pedicle was 8cm. All flaps survived. The systematic literature review identified 34 previous reports using the SCIP flaps, most of these published by Asian units. CONCLUSION The SCIP flap is useful for reconstruction throughout the body due to its ease of dissection, thinness, adjustable pedicle length, and flap dimension ranging from tiny to large, as well as the feasibility of raising a compound flap incorporating an adipofascial or vascularized bone component if necessary.This is a level of evidence therapeutic IV study.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital, Plastic Surgery Department, East Grinstead, United Kingdom.,Kellogg College, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Dariush Nikkhah
- Royal Free Hospital, Plastic Surgery Department, London, United Kingdom
| | - Jade Zhao
- Queen Victoria Hospital, Plastic Surgery Department, East Grinstead, United Kingdom
| | - Elena Prousskaia
- McIndoe Surgical Centre, East Grinstead, United Kingdom of Great Britain and Northern Ireland
| | - Tiew Chong Teo
- Queen Victoria Hospital, Plastic Surgery Department, East Grinstead, United Kingdom
| |
Collapse
|
39
|
Berner JE, Kyriazidis I, Blackburn A. Importance of Effective Retraction for Exposing Loose Areolar Plane in Suprafascial Deep Inferior Epigastric Perforator Flap Raising. Indian J Plast Surg 2019; 52:366-368. [PMID: 31908380 PMCID: PMC6938452 DOI: 10.1055/s-0039-3402356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Ioannis Kyriazidis
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Adam Blackburn
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| |
Collapse
|
40
|
Amirhassankhani S, Berner JE, Dheansa B. Re: Feasibility and safety of enzymatic debridement for the prevention of operative escharotomy in circumferential deep burns of the distal upper extremity. Surgery 2019; 167:512. [PMID: 31229311 DOI: 10.1016/j.surg.2019.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | - Juan Enrique Berner
- Queen Victoria Hospital, East Grinstead, United Kingdom; Kellogg College, University of Oxford, Oxford, United Kingdom.
| | | |
Collapse
|
41
|
Berner JE, Gokani V, Savage J, Blackburn A. Repeated never events in plastic surgery: Can human factors help us understand why we fail? J Plast Reconstr Aesthet Surg 2019; 73:184-199. [PMID: 31213397 DOI: 10.1016/j.bjps.2019.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust, Holtye Road, RH19 3DZ East Grinstead, United Kingdom; Kellogg College, University of Oxford. 60-62 Banbury Road OX2 6PN. Oxford, United Kingdom.
| | - Vimal Gokani
- Queen Victoria Hospital NHS Foundation Trust, Holtye Road, RH19 3DZ East Grinstead, United Kingdom
| | - Jessica Savage
- Queen Victoria Hospital NHS Foundation Trust, Holtye Road, RH19 3DZ East Grinstead, United Kingdom
| | - Adam Blackburn
- Queen Victoria Hospital NHS Foundation Trust, Holtye Road, RH19 3DZ East Grinstead, United Kingdom
| |
Collapse
|
42
|
Berner JE, Ewertz E. A response to «Non-technical skills in surgery: A pending subject». Cir Esp 2019; 97:421. [PMID: 31200918 DOI: 10.1016/j.ciresp.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Juan Enrique Berner
- Kellogg College, Universidad de Oxford, Oxford, Reino Unido; Departamento de Cirugía Plástica, Queen Victoria Hospital, East Grinstead, Reino Unido; Hospital del Trabajador, Santiago, Chile.
| | - Ernesto Ewertz
- Kellogg College, Universidad de Oxford, Oxford, Reino Unido; Departamento de Cirugía Plástica, Queen Victoria Hospital, East Grinstead, Reino Unido; Hospital del Trabajador, Santiago, Chile
| |
Collapse
|
43
|
Berner JE, Kamalathevan P, Kyriazidis I, Nduka C. Facial synkinesis outcome measures: A systematic review of the available grading systems and a Delphi study to identify the steps towards a consensus. J Plast Reconstr Aesthet Surg 2019; 72:946-963. [DOI: 10.1016/j.bjps.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/10/2019] [Accepted: 03/10/2019] [Indexed: 11/24/2022]
|
44
|
Berner JE, Ewertz E. The importance of non-technical skills in modern surgical practice. Cir Esp 2019; 97:190-195. [PMID: 30771999 DOI: 10.1016/j.ciresp.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 01/11/2023]
Abstract
The significance of technical skills and manual dexterity for surgeons is an indisputable fact. However, the systematic study of medical errors has revealed that a significant percentage of these errors are caused by factors related to non-technical skills. The review presented in this article intends to describe and explore the relevance of these non-technical skills, including: situational awareness, decision-making, leadership and communication. In conclusion, the authors propose that adequate importance needs to be given to these aptitudes to provide safe clinical care.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Kellogg College, Universidad de Oxford, Oxford, Reino Unido; Departamento de Cirugía Plástica, Queen Victoria Hospital, East Grinstead, Reino Unido.
| | | |
Collapse
|
45
|
Troisi L, Berner JE. Comments on "Reconstruction of an upper posterior thigh extensive defect with a free split-anterolateral thigh (s-ALT) flap by perforator-to-perforator anastomosis: A case report". Microsurgery 2018; 39:192. [PMID: 29953652 DOI: 10.1002/micr.30344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/05/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Luigi Troisi
- Department of Plastic and Reconstructive Surgery, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust, East Gristead, United Kingdom.,Kellogg College, Oxford, United Kingdom
| |
Collapse
|
46
|
Berner JE, Keckes D, Pywell M, Dheansa B. Limitations to the use of bromelain-based enzymatic debridement (NexoBrid ®) for treating diabetic foot burns: a case series of disappointing results. Scars Burn Heal 2018; 4:2059513118816534. [PMID: 30574406 PMCID: PMC6295758 DOI: 10.1177/2059513118816534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Bromelain-based enzymatic debridement with Nexobrid® (Mediwound) is an alternative to traditional surgical tangential excision of deep dermal and full thickness burns. Early literature suggests that Nexobrid debridement could reduce the number of operations, infection rates, inpatient stay and the necessity for skin grafting to wounds by preserving viable tissue. To our knowledge there are no previous studies reporting the use of NexoBrid for treating burns in patients with established diabetic foot disease. CASE PRESENTATION We conducted a retrospective case series and identified four patients with diabetic foot burns that were treated with Nexobrid® debridement. All of these patients developed further eschar and deepening of their wounds a few days after NexoBrid was applied, requiring further surgery and skin grafting. CONCLUSIONS We would recommend judicious use of this new product in patients with diabetic foot wounds.
Collapse
Affiliation(s)
- Juan Enrique Berner
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
- Kellogg College, University of Oxford, Oxford, UK
| | - Dejan Keckes
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Matthew Pywell
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Baljit Dheansa
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| |
Collapse
|
47
|
Vidal P, Berner JE. Is Rigid Nasal Splinting Needed after Rhinoplasties? An 18-year Experience Using Surgical Tape. Plast Reconstr Surg Glob Open 2016; 4:e1188. [PMID: 28293530 PMCID: PMC5222675 DOI: 10.1097/gox.0000000000001188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Pedro Vidal
- Clínica La Parva, Santiago, Chile; Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom; and Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Juan Enrique Berner
- Clínica La Parva, Santiago, Chile; Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom; and Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
48
|
Abstract
Hyperbaric oxygenation consists in exposing patients to increased gas pressures while inhaling pure oxygen. It involves the use of hyperbaric chambers that can double or triple gas pressure inside them. Hyperbaric oxygenation may be useful in different clinical situations, but mostly for the treatment of decompression syndrome. In the last decades, it has been used for the management of different kinds of wounds. Hyperbaric oxygenation not only increases the delivery of oxygen to damaged tissues, but also stimulates angiogenesis, collagen synthesis, stem cell migration and local immune response. Clinical trials that have addressed the use of hyperbaric oxygenation are difficult to compare due to their heterogeneity in terms of experimental design, kind of injuries involved and assessment of outcome. Even though, most studies support the concept that hyperbaric oxygenation accelerates the healing process.
Collapse
|
49
|
Berner JE, Vidal P. Visible vaccination scars. Medwave 2014; 14:e6025. [PMID: 25340745 DOI: 10.5867/medwave.2014.09.6025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Juan Enrique Berner
- Hospital Clínico Fuerza Aérea de Chile "Gral. Dr. Raúl Yazigi J." Address: Lo Fontecilla 101 oficina 412, Las Condes, Santiago, Chile. Email.
| | - Pedro Vidal
- Hospital Clínico Fuerza Aérea de Chile "Gral. Dr. Raúl Yazigi J."; Departamento de Cirugía Plástica, Escuela de Medicina, Pontificia Universidad Católica de Chile
| |
Collapse
|
50
|
Vidal P, Berner JE, Castillo P. Malar fat pad suspension through intraoral approach: a personal technique. Eur J Plast Surg 2014. [DOI: 10.1007/s00238-014-0954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|