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Flores MJ, Brown KE, MacKechnie MC, O’Marr JM, Rodarte P, Shearer DW. An Analysis of Participant Preferences Regarding Virtual Versus In-person Format of Orthopaedic Surgery Educational Materials in Low- and Middle-Income Countries. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00003. [PMID: 38437056 PMCID: PMC10906641 DOI: 10.5435/jaaosglobal-d-23-00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The University of California, San Francisco Institute for Global Orthopaedics and Traumatology Surgical Management and Reconstructive Training (SMART) course has instructed orthopaedic surgeons from low-resource countries on soft-tissue reconstruction. Before the COVID-19 pandemic, the course was conducted in-person; however, it was transitioned to a virtual format during the pandemic. The aim of this study was to determine participant preferences regarding a virtual or in-person SMART course format. METHODS Survey data were collected via e-mail after each SMART course using RedCap or Qualtrics. Statistical analyses were conducted using Stata. RESULTS There were 247 survey respondents from 44 countries representing all world regions, with Africa (125, 51%) the most represented. Of those who attended both an in-person and virtual course, most (82%) preferred the in-person format. In addition, all measured course outcomes were significantly better for participants attending the in-person course. The most common reason for not attending an in-person course was the cost of travel (38, 51%). DISCUSSION This study demonstrated a preference toward in-person learning for the SMART course. In addition, those surgeons participating in the in-person course endorsed increased positive outcomes from the course. Increased emphasis should be placed on in-person surgical skills training for low-resource surgeons.
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Affiliation(s)
- Michael J. Flores
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Kelsey E. Brown
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Madeline C. MacKechnie
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Jamieson M. O’Marr
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Patricia Rodarte
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - David W. Shearer
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
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Hoveidaei AH, Nakhostin-Ansari A, Namdari S, Hosseini-Asl SH, Khonji MS, Selk-Ghaffari M, Pouramini A, LaPorte DM. Increasing Burden of Upper-Extremity Fractures in the Middle East and North Africa (MENA): A 30-Year Analysis of the Epidemiology and Causes of Injuries. J Bone Joint Surg Am 2024; 106:323-336. [PMID: 38000016 DOI: 10.2106/jbjs.23.00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Upper-extremity fractures (UEFs) account for a large proportion of bone fractures and are costly to both health and the economy. The fracture burden in the Middle East and North Africa (MENA) is influenced by the region's diverse cultural, economic, and political status. This study examined UEF epidemiology and causes across the MENA region and within the 21 MENA countries as categorized by the Global Burden of Disease (GBD) data set. METHODS On the basis of GBD data, this study evaluated the epidemiology of UEFs from 1990 to 2019. The causes of injuries, incidence, number of years of healthy life lost due to disability (YLD), and their association with the Socio-demographic Index (SDI) were obtained and calculated for males and females in all age groups. RESULTS From 1990 to 2019, the age-standardized incidence rate (ASIR) of UEFs in the MENA region increased by 2.33%, to 1,086.39 per 100,000 people, and the YLD rate increased 15.69%, to 9.17 per 100,000, opposing the global decreasing trends. Fractures of the radius and/or ulna had the highest ASIR (505.32 per 100,000) of all UEF types in 2019. The clavicle, scapula, and humerus had the highest increasing trend among the fracture sites. In 2019, Saudi Arabia had the highest ASIR of UEFs (2,296.93 per 100,000). Afghanistan had the highest age-standardized YLD rate due to UEFs (19.6 per 100,000) in 2019, with Syria (153.32%) and Iran (37.04%) experiencing the greatest increase and decrease, respectively, from 1990 to 2019. Falling was the leading cause of UEFs, accounting for 45.05% of incidence and 41.19% of YLD overall. CONCLUSIONS Contrary to global trends, UEFs increased in the MENA region during the study period. Countries with higher fracture incidence and YLD should consider preventive and rehabilitation strategies.
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Affiliation(s)
- Amir Human Hoveidaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Surena Namdari
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Seyed Hossein Hosseini-Asl
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saeid Khonji
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Selk-Ghaffari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouramini
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Dawn M LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Lansford JL, McCarthy CF, Souza JM, Saberski ER, Potter BK. Preventing biological waste: Effective use of viable tissue in traumatized lower extremities. OTA Int 2023; 6:e242. [PMID: 37448566 PMCID: PMC10337847 DOI: 10.1097/oi9.0000000000000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 07/15/2023]
Abstract
Severe open lower extremity trauma requires debridement to remove contamination and devitalized tissues. Aggressive debridement should be balanced with preservation of viable tissue. These often damaged but preserved viable tissues are "spare parts" that augment the options available for reconstruction. The long-term goal of reconstruction should be functional limb restoration and optimization. Injury patterns, levels, and patient factors will determine whether this endeavor is better accomplished with limb salvage or amputation. This article reviews the rationale and strategies for preserving spare parts throughout debridement and then incorporating them as opportunistic grafts in the ultimate reconstruction to facilitate healing and maximize extremity function. Level of Evidence 5.
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Affiliation(s)
| | | | - Jason M. Souza
- Ohio State University College of Medicine, Columbus, OH; and
| | - Ean R. Saberski
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of Health Sciences, Bethesda, MD
| | - Benjamin K. Potter
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of Health Sciences, Bethesda, MD
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MacKechnie MC, Albright PD, Garabano G, Bidolegui F, Pereira S, Pesciallo CA, Miclau T. Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings. OTA Int 2022; 5:e209. [PMID: 36425094 PMCID: PMC9580262 DOI: 10.1097/oi9.0000000000000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 06/16/2023]
Abstract
Background Argentina is a country with varying access to orthopedic surgical care. The Argentine Association of Trauma and Orthopedics (AATO) "Interior Committee" was developed to address potential regional differences and promote standardization of orthopedic trauma care. The paper assesses the level of national standardization of the management of open tibia fractures across 9 provinces in Argentina. Methods Utilizing a matched-comparison group design, management of these injuries were assessed and compared between 3 groups: an "AATO Exterior Committee" consisting of surgeons that practice in Buenos Aires, and 2 "Interior Committees," comprising surgeons that practice in outlying provinces, 1 of which is affiliated with the AATO, and 1 that is not affiliated with the AATO. The study was conducted in 2 phases: phase 1 assessed open tibia fracture management characteristics, and phase 2 evaluated the management of soft-tissue wound coverage following open fractures. Results Soft-tissue coverage procedures for Gustilo Anderson Type IIIB fractures were more commonly performed by orthopedic surgeons in Interior Committees than the AATO Exterior Committee. Greater rates of definitive wound coverage within 7 days post-injury were reported in both Interior Committees compared to the Exterior Committee. Plastic surgeons were reported as more available to those in the AATO Exterior Committee group than in the AATO Interior Committees. Conclusion While treatment patterns were evident among groups, differences were identified in the management and timing of soft-tissue coverage in Gustilo Anderson Type IIIB fractures between the Exterior Committee and both Interior Committees. Future targeted educational and surgical hands-on training opportunities that emphasize challenges faced in resource-limited settings may improve the management of open tibia fractures in Argentina.
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Affiliation(s)
- Madeline C MacKechnie
- Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Patrick D Albright
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | | | | | | | | | - Theodore Miclau
- Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
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Miclau T, MacKechnie MC, Born CT, MacKechnie MA, Dyer GSM, Yuan BJ, Dawson J, Lee C, Ishmael CR, Schreiber VM, Tejwani NC, Ulmer T, Shearer DW, Agarwal-Harding KJ, Johal H, Khormaee S, Sprague S, Whiting PS, Roberts HJ, Coughlin R, Gosselin R, Rosenwasser MP, Johnson A, Babu JM, Dworkin M, Makhni MC, McClellan T, Nwachuku CO, Miclau E, Morshed S. International Orthopaedic Volunteer Opportunities in Low and Middle-Income Countries. J Bone Joint Surg Am 2022; 104:e44. [PMID: 34932526 DOI: 10.2106/jbjs.21.00948] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Globally, the burden of musculoskeletal conditions continues to rise, disproportionately affecting low and middle-income countries (LMICs). The ability to meet these orthopaedic surgical care demands remains a challenge. To help address these issues, many orthopaedic surgeons seek opportunities to provide humanitarian assistance to the populations in need. While many global orthopaedic initiatives are well-intentioned and can offer short-term benefits to the local communities, it is essential to emphasize training and the integration of local surgeon-leaders. The commitment to developing educational and investigative capacity, as well as fostering sustainable, mutually beneficial partnerships in low-resource settings, is critical. To this end, global health organizations, such as the Consortium of Orthopaedic Academic Traumatologists (COACT), work to promote and ensure the lasting sustainability of musculoskeletal trauma care worldwide. This article describes global orthopaedic efforts that can effectively address musculoskeletal care through an examination of 5 domains: clinical care, clinical research, surgical education, disaster response, and advocacy.
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Affiliation(s)
- Theodore Miclau
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Madeline C MacKechnie
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Christopher T Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael A MacKechnie
- Department of Orthopaedic Surgery, Cleveland Clinic Martin Health, Stuart, Florida
| | - George S M Dyer
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - John Dawson
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Cassandra Lee
- Department of Orthopaedic Surgery, University of California at Davis Health, Sacramento, California
| | - Chad R Ishmael
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | | | - Todd Ulmer
- Adventist Medical Center, Oregon Health Sciences University, Portland, Oregon
| | - David W Shearer
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Kiran J Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Massachusetts General Hospital/Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Herman Johal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Heather J Roberts
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Richard Coughlin
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Rich Gosselin
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | | | - Anthony Johnson
- Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, Texas
| | - Jacob M Babu
- Orthopaedic Division of Spine Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Myles Dworkin
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melvin C Makhni
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Trigg McClellan
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | | | - Elizabeth Miclau
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Saam Morshed
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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Management of soft-tissue coverage of open tibia fractures in Latin America: Techniques, timing, and resources. Injury 2022; 53:1422-1429. [PMID: 35101259 DOI: 10.1016/j.injury.2022.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study examined soft-tissue coverage techniques of open tibia fractures, described soft-tissue treatment patterns across income groups, and determined resource accessibility and availability in Latin America. METHODS A 36-question survey was distributed to orthopaedic surgeons in Latin America through two networks: national orthopaedic societies and the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR). Demographic information was collected, and responses were stratified by income groups: high-income countries (HICs) and middle-income countries (MICs). RESULTS The survey was completed by 469 orthopaedic surgeons, representing 19 countries in Latin America (2 HICs and 17 MICs). Most respondents were male (89%), completed residency training (96%), and were fellowship-trained (71%). Only 44% of the respondents had received soft-tissue training. Respondents (77%) reported a strong interest in attending a soft-tissue training course. Plastic surgeons were more commonly the primary providers for Gustilo Anderson (GA) Type IIIB injuries in HICs than in MICs (100% vs. 47%, p<0.01) and plastic surgeons were more available (<24 h of patient presentation to the hospital) in HICs than MICs (63% vs. 26%, p = 0.05), demonstrating statistically significant differences. In addition, respondents in HICs performed free flaps more commonly than in MICs for proximal third (55% vs. 10%, p<0.01), middle third (36% vs. 9%, p = 0.02), and distal third (55% vs. 10%, p<0.01) lower extremity wounds. Negative Pressure Wound Therapy (NPWT or Wound VAC) was the only resource available to more than half of the respondents. Though not statistically significant, surgeons reported having more access to plastic surgeons at their institutions in HICs than MICs (91% vs. 62%, p = 0.12) and performed microsurgical flaps more commonly at their respective institutions (73% vs. 42%, p = 0.06). CONCLUSIONS The study demonstrated that most orthopaedic surgeons in Latin America have received no soft-tissue training, HICs and MICs have differences in access to plastic surgeons and expectations for flap type and timing to definitive coverage, and most respondents had limited access to necessary soft-tissue surgical resources. Further investigation into differences in the clinical outcomes related to soft-tissue coverage methods and protocols can provide additional insight into the importance of timing and access to specialists.
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Holler JT, MacKechnie MC, Albright PD, Morshed S, Shearer DW, Terry MJ. The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3272. [PMID: 33425587 PMCID: PMC7787316 DOI: 10.1097/gox.0000000000003272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022]
Abstract
Managing lower extremity fractures complicated by large soft-tissue defects is challenging for surgeons in low- and middle-income countries, and long-term quality of life (QOL) for these patients is unclear. METHODS We examined QOL, surgical complications, and longitudinal outcomes in 10 patients with Gustilo-Anderson Classification Type IIIB open tibia fractures seen at an orthopedic institute in Tanzania, from December 2015 to March 2017. Patients completed follow-up at 2-, 6-, 12-, 26-, and 52-week time points, and returned for qualitative interviews at 2.5 years. The primary outcome was QOL, as measured using EuroQoL-5D scores and qualitative semi-structured interview responses. The secondary outcome was rate of complication, as defined by reoperation for deep infection or nonunion. RESULTS Ten patients enrolled in the study and 7 completed 1-year follow-up. All fractures were caused by road traffic accidents and treated by external fixation. No patients received initial soft-tissue (flap) coverage of the wound. All patients developed an infected nonunion. No patients returned to work at 6 weeks, 3 months, or 6 months. EQ-5D index scores at 1 year were poor (0.71 ± 0.09). Interview themes included ongoing medical complications, loss of employment, reduced income, and difficulty with activities of daily living. CONCLUSIONS Patients in low- and middle-income countries with IIIB open tibia fractures not treated with appropriate soft-tissue coverage experience poor QOL, high complication rates, and severe socioeconomic effects as a result of their injuries. These findings illustrate the need for resources and training to build capacity for extremity soft-tissue reconstruction in LMICs.
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Affiliation(s)
- Jordan T. Holler
- From the UCSF School of Medicine, University of California, San Francisco, Calif
| | - Madeline C. MacKechnie
- Institute for Global Orthopedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Calif
| | - Patrick D. Albright
- Department of Orthopaedic Surgery, University of Minnesota – Medical School, Minneapolis, Minn
| | - Saam Morshed
- Institute for Global Orthopedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Calif
| | - David W. Shearer
- Institute for Global Orthopedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Calif
| | - Michael J. Terry
- Division of Plastic and Reconstructive Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, Calif
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Wood TT, Roberts HJ, Stinner DJ. Being Prepared for the Next Conflict Part II: Case Analysis of a Military Level 1 Trauma Center. Mil Med 2020; 185:e1235-e1239. [DOI: 10.1093/milmed/usaa054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Combat-related injuries have declined substantially in recent years as we have transitioned to a low-volume combat casualty flow era. Surgeons must remain actively committed to training for the next engagement to maintain life and limb-saving skills. Soft tissue coverage procedures were imperative to the management of complex lower extremity trauma that occurred during recent conflicts. The purpose of this study was to evaluate advanced soft tissue coverage procedures performed on the lower extremity over the previous decade on military and civilian trauma patients at a Department of Defense Level 1 trauma center to provide data that can be used to guide future training efforts.
Materials and Methods
The electronic surgical record system was searched for cases that utilized advanced soft tissue coverage (rotational and free flaps) to the lower extremity. The date of treatment, indication, procedure performed, and military/civilian patient designation were recorded. The data was categorized between military and civilian cases, rotational versus free flap, and indication and then charted over time. It was assessed as moving averages over a 12-month period. Statistically distinct periods were then identified.
Results
From January 2006 to March 2015, 132 advanced soft tissue coverage procedures were performed on the lower extremity (100 military, 32 civilian). Military soft tissue coverage data demonstrated peaks in 2007 and late 2011 to late 2012, averaging 6.5 (3.5–9.6) and 4.5 (3.2–5.8) per quarter, respectively. There were two low periods, from 2008 to mid-2010 and from mid-2012 to the end of the study, averaging 1.1 (0.6–1.6) and 1.8 (1.1–2.6) cases per quarter, respectively. Civilian procedures averaged 0.9 per quarter (0.5–1.2) throughout the study, but notably were equal to the number of military procedures by the last quarter of 2013 at 2.0 (1.2–2.8 civilian, 0.8–3.1 military).
Conclusions
This data supports prior identified trends in military cases correlating increased number of procedures with increased combat activity related to the conflicts in Iraq and Afghanistan in 2007 and 2011, respectively. The data showed relative stability in the numbers of civilian procedures with a slight uptrend beginning in mid-2012. A comparison after mid-2012 shows military procedures declining and civilian procedures increasing to eventually become equivalent at the end of the data collection. These trends follow previously reported data on tibia fracture fixation procedures and lower extremity amputations for the same time periods. These data demonstrate the importance of the civilian trauma mission for maintaining surgical skills relevant to limb salvage, such as rotational and free flaps, during a low-volume combat casualty flow era.
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Affiliation(s)
- Thomas T Wood
- Keesler Medical Center, 301 Fisher Street, Keesler AFB, MS 39534
| | - Haydn J Roberts
- Department of Orthopaedics, University of Arizona-Tucson, 1501 N. Campbell Ave., Tucson, AZ 85724
| | - Daniel J Stinner
- Blanchfield Army Community Hospital, Fort Campbell, KY 42223
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
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Knowledge deficits and barriers to performing soft-tissue coverage procedures: An analysis of participants in an orthopaedic surgical skills training course in Mexico. OTA Int 2019; 2:e044. [PMID: 33937672 PMCID: PMC7997122 DOI: 10.1097/oi9.0000000000000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023]
Abstract
Background: An increasing number of traumatic injuries in low- and low-middle-income countries (LICs/LMICs) have coexisting injuries requiring soft-tissue coverage (flaps). Yet, there is a lack of subspecialty care and flap training in Latin America. This study assesses the effectiveness of a surgical skills training course in improving rotational and free flap knowledge and identifies barriers to performing these types of flaps. Methods: Participants attending a surgical skills training course in Guadalajara, Mexico completed a pre/postcourse flaps knowledge survey consisting of 15 questions from the plastic surgery in-training examination and also completed a 7-point Likert survey regarding perceived barriers to performing flaps at their institution. Results: Of the course participants, 17 (44.7%) completed the precourse knowledge survey, 24 (63.2%) completed the postcourse survey, and 37 (97.4%) completed the barriers survey. Scores improved from pre- to postcourse knowledge surveys (39.6% to 53.6%, P = .005). Plastic surgery subsection scores also improved (39.0% to 60.4%, P = .003). Twenty-five percent of attendees received prior flap training and had plastic surgeons available to perform flaps. Few participants (38.9%) reported flap procedures being commonly completed at their hospitals. Participants stating that flaps were uncommon in their hospital reported more institutional barriers and less access to dermatomes. These participants also reported lack of operating room and surgical personnel availability. Conclusion: A surgical skills training course may be useful in improving knowledge of soft-tissue coverage procedures. There are also modifiable physician and institutional barriers that can improve the ability to perform rotational and free flaps as identified by the course participants.
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Barriers to Performing Soft Tissue Reconstruction Procedures among Orthopedic Surgeons in Low- and Middle-income Countries: Results of a Surgical Skills Training Course. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2420. [PMID: 31772876 PMCID: PMC6846298 DOI: 10.1097/gox.0000000000002420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
Appropriate management of soft tissue injury associated with orthopedic trauma is challenging in low- and middle-income countries (LMICs) due to the lack of available reconstructive surgeons. The Surgical Management and Reconstructive Training (SMART) course teaches orthopedic surgeons reconstructive techniques aimed at improving soft tissue management. This study aims to identify additional barriers to implementing these techniques for surgeons in LMICs who have attended SMART courses.
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