Plastic & Reconstructive Surgery

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Research outputs from the Plastics & Reconstructive Surgery and Plastics Rehabilitation teams at the RD&E.


Recent Submissions

Now showing 1 - 5 of 158
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    Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip: Three-Dimensional Morphometric- and Panel Assessment-Based Outcome Study
    (Lippincott, Williams & Wilkins, 2023-04-01) Denadai, R.; Tangco, I.; Valentine, M.; Wallace, C. G.; Hsiao, Y. C.; Huang, J. J.; Chang, F. C.; Lo, L. J.; Chen, J. P.; Chen, Y. R.
    SUMMARY: Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. Consecutive young adult patients (n=13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for 3D morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. 3D morphometric analysis revealed a significant (all p<0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference (p>0.05) between cleft and noncleft sides. The postoperative 3D projection of the philtral ridges was significantly (p<0.001) larger in cleft (1.01±0.43 mm) than noncleft sides (0.51±0.42 mm). The average philtrum volume change was 1.01±0.68 cm3, with an average percentage fat graft retention of 43.36±11.35 percent. The panel assessment revealed significant (p<0.001) postoperative scar enhancement for qualitative rating scale, with mean preoperative and postoperative scores of 6.69±0.93 and 7.88±1.14, respectively. Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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    The global FESSH green survey: sustainability in hand surgery
    (Sage, 2022-08-30) Witt, P.; Ayhan, E.; Hagert, E.; Naqui, Z.
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    Lip symmetry following rotation advancement cleft lip repair in 5-year-old children treated by Ralph Millard and Ron Pigott
    (Elsevier, 2022-09-01) Maggiulli, F.; Hinton, C.; Simpson, L.; Gujral, S.; Hardwicke, J.; Slator, R.; Pigott, R. W.; Su, T. L.; Richard, B.
    OBJECTIVE: To compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. DESIGN: Retrospective study of photographs of children aged 5 years. SETTING: Three decades of post-operative photographs of children treated by Millard and Pigott. PATIENTS: Eighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. INTERVENTIONS: Photographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. MAIN OUTCOME MEASURES: Asymmetry score for each surgeon, and non-cleft children. RESULTS: There was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (P = 0.59). CONCLUSIONS: Cleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.
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    COVID-19 Countermeasures: An Algorithm to Stay Unlocked
    (Medknow Publications, 2022-06-17) Izadi, D.; Da Silva, E. J.; Banwell, M. E.; Wallace, C. G.
    We describe a visual algorithm to help prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contagion as well as manage COVID-19 disease according to categories of clinical severity. The algorithm is timely, with multiple countries worldwide declaring repeat surges in SARS-CoV-2 infections following the easing of lockdown measures. Its flowchart assimilates key effective interventions in a visual manner that will assist healthcare workers to manage COVID-19 disease algorithmically, and policymakers to suppress further SARS-CoV-2 waves. Importantly, we include the innovative use of topical p-menthane-3,8-diol spray by the British Army for COVID-19 Support Force personnel, which in light of its coronavirucidal properties, deserves wider dissemination. This algorithm has the potential to be updated as numerous studies are concluded globally.
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    122 Tetanus Prophylaxis for Injuries Referred to a Plastic Surgery Service
    (Wiley, 2022-02-28) Stark, D.; Nagrath, N.
    To ascertain whether there is appropriate documentation of tetanus immunisation status. To determine whether appropriate tetanus prophylaxis is offered to those with an incomplete or unknown immunisation history for tetanus prone and high-risk tetanus prone wounds. To improve adherence to the green book of immunisation tetanus guidance.We performed an audit of wounds referred to plastic surgery in a 3-week period to ascertain whether the green book guidance was satisfied. A poster intervention for junior colleagues that illustrated the guidance was implemented. Re-audit was performed.Tetanus immunisation status was documented in 17 (34%) patients. Of 22 with tetanus prone wounds, 11 (50%) had an incomplete tetanus immunisation, but only 3 (27%) received a booster vaccine. Of the 11 high risk tetanus prone wounds, 10 (91%) had an incomplete tetanus immunisation status, but only 5 (50%) received a booster vaccine and none were offered tetanus immunoglobulins.Following intervention, tetanus immunisation status was documented in 23 (46%) patients. In the re-audit, 12 (24%) sustained a tetanus prone injury and 4 (33%) of these had complete immunisation. Of the remaining 8, 7 (88%) received a booster vaccine and 1 patient refused. Of the 4 high risk tetanus prone wounds, 3 (75%) had an incomplete tetanus immunisation status, all of whom received a booster vaccine and 1 (25%) was offered tetanus immunoglobulins.We observed greater engagement with the tetanus immunisation guidance and improvement in the assessment and management of tetanus prone injuries.