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Mabvuure NT, Pinto-Lopes R, Bolton L, Tzafetta K. Staged upper and lower lip reanimation following facial palsy: Peer-reviewed, patient-rated and objective outcomes. J Plast Reconstr Aesthet Surg 2022; 75:1861-1869. [PMID: 35396191 DOI: 10.1016/j.bjps.2022.02.078] [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: 02/08/2021] [Revised: 01/22/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND One approach to reanimating both upper and lower lips following facial palsy is through staged surgery: cross-face nerve grafting at stage I, free gracilis muscle transfer to levators at stage II and pedicled anterior belly of digastric muscle transfer (ABDMT) to depressors at stage III. The results of this approach were hitherto unquantified. METHODS This study retrospectively assessed peer-reviewed, patient-rated and objective outcomes following staged reanimation in adults between 2010 and 2020. Demographics, palsy characteristics and surgery details were recorded. Pre- and postoperative videos were rated by independent assessors using Terzis' aesthetic and symmetry scale. Photographs were analysed using Emotrics and patients completed the Glasgow Benefit Inventory (GBI) patient-rated outcome measure. RESULTS Ten patients [mean age = 34 (SD = 12.48)] were eligible. All regained lip elevation and depression. All markers of symmetry improved after gracilis transfer. All markers were also improved after ABDMT except for lower lip height when smiling with teeth showing (p > 0.05). Five patients (50%) responded to the GBI (mean score = +39.44). No patients reported detriment from the reanimations. Mean Terzis' scores preoperatively and after stages II and III were 1.5, 2.26 and 2.39, respectively (p < 0.05). Nine patients underwent aesthetic refinements [lipofilling to lower lip notches (n = 5), debulking of gracilis bulk (n = 6), repositioning of muscle insertion (n = 5) and facelifts (n = 2)]. CONCLUSION The outcomes were positive objectively and as judged by peers and patients themselves. Aesthetic refinements may also be required to enhance these results.
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Affiliation(s)
- Nigel Tapiwa Mabvuure
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom.
| | - Rui Pinto-Lopes
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
| | - Lauren Bolton
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
| | - Kallirroi Tzafetta
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, United Kingdom
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Mabvuure NT, Pinto-Lopes R, Bolton L, Tzafetta K. Lower lip depressor reanimation using anterior belly of digastric muscle transfer improves psychological wellbeing in facial palsy patients. Br J Oral Maxillofac Surg 2021; 60:299-307. [PMID: 34839999 DOI: 10.1016/j.bjoms.2021.07.025] [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: 04/12/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
The authors previously published positive peer-reviewed (21 raters using the Terzis scale) and photogrammetric (Emotrics) outcomes in patients who had undergone two-stage lower lip reanimations up to 2018. Other series have published surgeon and peer-rated results, but we know of only two (n=12) that have assessed patients' views using patient satisfaction surveys. This paper presents patient-rated outcomes (PROMS) in an 11-year series of both single and two-stage anterior belly of digastric muscle (ABDM) lower lip reanimations. Demographics, paralysis characteristics, operative details, and complications were recorded. Patients were telephoned and requested to complete the Glasgow Benefit Inventory (GBI) to assess patient-rated outcomes. Thirty-two patients were eligible (mean age 36.4 years). Twenty-one (63.6%) completed the GBI (mean score +33.3). More patients reported benefit than detriment (95.2% vs 4.8%). Complications were infrequent and included three cases of superficial infections and one of dermatitis. Four patients (12.5%) underwent minor revisions, mostly lipofilling of lip notches. The median (range) duration of follow up was 2.8 (0.3 - 8.5) years. ABDM transfer for lower lip reanimation is a safe, low morbidity procedure that enhances the psychological wellbeing of patients with facial palsy.
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Affiliation(s)
| | - Rui Pinto-Lopes
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
| | - Lauren Bolton
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
| | - Kallirroi Tzafetta
- St Andrews' Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
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Arkoulis N, Mabvuure NT, Smith A, Barnes DE. Early experiences using bromelain-based enzymatic debridement in a tertiary burns centre in the United Kingdom: A retrospective case series review. J Plast Reconstr Aesthet Surg 2020; 74:1402-1407. [PMID: 33388270 DOI: 10.1016/j.bjps.2020.12.028] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/05/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The modern ethos of burn care requires a holistic approach that helps patients to not only survive but also maintain a good quality of life. Bromelain-based enzymatic debridement with Nexobrid™ (NXB) has been shown to selectively debride burnt tissue and allow dermal preservation, which has the potential to reduce surgical burden and improve scarring. In this study, early experience with the use of Nexobrid™ at a tertiary burns centre between July 2016 and December 2019 is presented. In particular, the study assessed whether NXB had changed the acute care delivered to this cohort. METHODS A retrospective analysis of the patients' records was performed. Results were analysed and presented in the context of current literature. RESULTS Twenty adult patients (17 male, 3 female) underwent enzymatic debridement with NXB. Median age was 42.5 years. Mean total burn surface area (TBSA) on admission was 20%. Twelve patients were admitted to the intensive care unit, and eight were admitted to the adult burns ward. Mean TBSA treated with NXB was 8.2%, usually within 24 h of admission (mean). All patients had anaesthetist-led analgesia. NXB debridement was successful in 55% of patients, obviating the need for escharotomy in some patients. Sixty percent of all patients required further surgery, and 80% of facial burns treated with NXB required further surgery. Inotrope support was associated with NXB failure (p = 0.015). Mean length of stay was 29 days. DISCUSSION Current evidence, including our own findings, cannot justify replacing the current surgical standard of care with NXB, but it certainly solidifies enzymatic debridement as a useful adjunct that should form part of the modern burn surgeon's armamentarium.
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Affiliation(s)
| | | | - Alex Smith
- St Andrew's Burns Service, Broomfield Hospital, Chelmsford, UK
| | - David E Barnes
- St Andrew's Burns Service, Broomfield Hospital, Chelmsford, UK
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Mabvuure NT, Klimach S, Hallam MJ, Nduka C. A simple computerised technique for estimating resting lip position and symmetry. J Plast Surg Hand Surg 2020; 55:123-126. [PMID: 33124495 DOI: 10.1080/2000656x.2020.1838915] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The angle between the commisure-commisure and the endocantus-commisure lines (CCE angle) is approximately equal to the contralateral angle. A computerised technique for assessing the gross symmetry and position of the lips by comparing left- and right-sided CCE angles was developed. This study established (1) the repeatability of computerized CCE angle measurement; (2) mean CCE angle magnitudes in healthy controls and suggest a "normal" reference range. Two authors independently measured CCE angles on frontal repose facial photographs of 104 volunteers on three separate occasions using facial analysis software. Twenty right-sided hemifaces with the largest CCE differences were then mirrored in the sagittal plane to produce symmetrical photographs. Measurements were repeated by a single author. There was high agreement of angle measurements between authors (inter-rater ICC of 0.89) and within each authors' repeated measurements (intra-raters ICCs of 0.85 and 0.77). Differences in the mean right and left-sided CCE angles in controls were small but statistically significant (82.4° and 81.7°, respectively, mean absolute difference 2.2 ± 1.7°, p < 0.05). The mean absolute differences had a skewed distribution. The 2.5th and 97.5th centiles were therefore set as limits of the range of asymmetries which could be regarded as "normal" (95% reference range, or 95% reference interval): 0.2°-6.2°. Measurements of opposing CCE angles in symmetrical mirrored images were similar (82.4° versus 82.3°, mean absolute difference 0.6°, p > 0.05). In conclusion, computerised CCE angle measurement is highly repeatable and may be a useful tool with which to assess gross resting lip symmetry.
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Affiliation(s)
| | | | - Marc-James Hallam
- Plastic Surgery Department, Aberdeen Royal infirmary, Aberdeen, Scotland, UK
| | - Charles Nduka
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK
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Mabvuure NT, Pinto-Lopes R, Iwuagwu FC, Sierakowski A. A systematic review of outcomes following hand reconstruction using flaps from the superficial palmar branch of the radial artery (SUPBRA) system. J Plast Reconstr Aesthet Surg 2020; 74:79-93. [PMID: 33067122 DOI: 10.1016/j.bjps.2020.08.132] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Flaps based on the superficial branch of the radial artery (SUPBRA) are indicated when homo- or heterodigital flaps are inappropriate, but glabrous or like-for-like reconstruction is required. AIM To systematically review the outcomes of hand reconstruction using SUPBRA flaps. METHODS PubMed was searched for English-language articles studying SUPBRA flaps in November 2019. Data collected included flap vascular supply, dimensions, complications, donor site closure, and two-point discrimination. RESULTS Twenty-six papers were eligible (410 flaps). Flaps were classified as glabrous, nonglabrous or combined. Nonglabrous flaps were either free- (52%) or reverse-flow pedicled (1.7%) wrist flaps. Glabrous flaps were either free palmar (36.3%), reverse-flow pedicled palmar (2%), antegrade-flow pedicled palmar (0.2%) or perforator-based island palmar flaps (3.7%). Combined glabrous/nonglabrous flaps formed 4.1% of flaps. Maximal flap dimensions allowing direct closure were: 3.1 × 6 cm for wrist flaps and <3 × 10 cm for glabrous palmar flaps. Combined flaps can be 10 × 16 cm. Overall, complete and partial flap failure rates were 3.17% and 0.98%, respectively. Most complete failures were due to venous thrombosis. All 220 wrist donor sites were closed directly. Two out of 173 palmar donor sites (≥3.1) could not be primarily closed. Wound complications were rare, but 53.4% of free palmar flaps required debulking. The results of neurorrhaphy were inconsistent. CONCLUSIONS Flaps based on the SUPBRA are robust, provide like-for-like reconstruction of glabrous skin defects in one-stage, offer versatility due to diverse skin paddle orientation patterns and are in the same operative field as the defect.
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Affiliation(s)
- N T Mabvuure
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom.
| | - R Pinto-Lopes
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom
| | - F C Iwuagwu
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom
| | - A Sierakowski
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom
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Abstract
Moist exposed burn ointment (MEBO) is an oil-based herbal paste, purported to be efficacious in managing burn wounds and more commonly used in Asia and the Middle East. A PRISMA-compliant systematic review was performed to analyse the evidence for the use of MEBO on burn wounds. Wound healing rate was the primary outcome of interest. PubMed-listed randomised controlled trials (RCTs) comparing the efficacy of MEBO with placebo, standard care or other therapies in the treatment of partial thickness burns in adults and children were eligible for inclusion (November 2019). Six RCTs were eligible. The majority of trials comparing wound healing between MEBO and SSD favoured MEBO (two of three). There may be improved healing in MEBO-treated wounds vs. those treated with povidone-iodine + bepanthenol cream. There was no difference between MEBO and Acquacel Ag, but Helix Aspersa had faster healing rates than MEBO. However, all evidence was from moderately to poorly reported trials with a high risk of bias, thereby limiting the strength of this evidence. In conclusion, the evidence for MEBO in English-language literature was poor and inconsistent with respect to wound healing rate and analgesis compared to 1% SSD, Acquacel Ag, Helix aspersa cream and povidone-iodine + bepanthenol cream. Blinded RCTs comparing MEBO to both placebo and other common topical treatments may further improve the confidence in concluding their analysis. There is some evidence that MEBO is as safe as its comparators as shown by the low complication rate.
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Affiliation(s)
| | | | - Kevin Gervin
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, UK
| | - Siobhan Duffy
- Greater Glasgow and Clyde NHS Health Board, Glasgow, UK
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Mabvuure NT, Pinto-Lopes R, Sierakowski A. Management of intraarticular proximal interphalangeal joint fracture-dislocations and pilon fractures with the Ligamentotaxor® device. Arch Orthop Trauma Surg 2020; 140:1133-1141. [PMID: 32448930 DOI: 10.1007/s00402-020-03482-8] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Fracture-dislocation and pilon injuries of the proximal interphalangeal joints (PIPJ) continue to pose significant management challenges. Stable fracture configurations can be treated with extension block splinting or pinning. Unstable fractures usually require open or closed reduction and fixation either directly/internally onto the fracture using Kirschner wires, cerclage wires, screws or miniplates or indirectly/externally by ligamentotaxis using external fixators which can be dynamic or static. Dynamic external fixators, such as Suzuki's pins and rubber traction system, S-Quattro and Hynes/Giddins frame, appear intuitive as they provide axial distraction, which reduces the fracture whilst obviating the need to open the fracture. They also allow immediate active movement whilst maintaining reduction. The Ligamentotaxor® (Arex, Pallaiseau Cedex, France) is a commercially-available dynamic external fixator which has been used at our institution since 2013. MATERIALS AND METHODS This retrospective study assessed the outcomes (interphalangeal joint active range of movement (AROM), QuickDASH score and complications) in 19 patients [mean age of 48.6 (SD 16.2)] whose proximal interphalangeal joint (PIPJ) fracture-dislocations and/or pilon fractures were treated with the Ligamentotaxor®. Injuries were classified according to Seno i.e. (1) volar lip fracture ± dorsal dislocation (2) dorsal lip fracture ± volar dislocation (3) pilon fracture. RESULTS There were fifteen (79%) pilon/Seno 3, three (16%) Seno 1 and one (5%) Seno 2 fractures. The mean PIPJ AROM was 70.6° (SD 4.48°) for all Seno classes and 70° (SD 5.6°) for the pilon subgroup. The QuickDASH score averaged to 2.65 (SD 0.88). There were two pin-site infections, three pin-site inflammations, one osteomyelitis and two complex regional pain syndrome diagnoses. One patient required arthroplasty after missing several appointments. CONCLUSIONS These results, considering the predominance of pilon fractures, compare favourably the published Ligamentotaxor® and other dynamic external fixator systems.
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Affiliation(s)
- Nigel Tapiwa Mabvuure
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK.
| | - Rui Pinto-Lopes
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK
| | - Adam Sierakowski
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK
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Mabvuure NT, Pinto-Lopes R, Fernandez-Diaz O, Tzafetta K. The mini-temporalis turnover flap for midface reanimation: Photogrammetric and patient-rated outcomes. J Plast Reconstr Aesthet Surg 2020; 73:2185-2195. [PMID: 32561385 DOI: 10.1016/j.bjps.2020.05.059] [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: 02/09/2020] [Revised: 04/02/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mini-temporalis transposition (MTT) flaps, modified from Gillies' technique, have become less popular than temporalis tendon transfers for midface reanimation. MTT involves raising the middle third of the temporalis, transposition over the zygomatic arch and lengthening with deep temporalis fascia which is sutured to the orbicularis oris. AIM This retrospective study assessed subjective and objective outcomes following MTTs by a single surgeon from 2009 to 2019. METHODS Operative and surgical details were recorded. Four blinded consultants rated pre- and postoperative videos according to Terzis' scale. Pre- and postoperative resting, Mona Lisa and canine smile photographs were analysed using Emotrics, the software that automatically computes differences in inter-landmark distances. Patients also completed the Glasgow Benefit Inventory (GBI) patient-rated outcome measure. RESULTS Forty-one patients (mean age 65.8 ± 15.5) underwent MTT, median 3 (0.4-57) years post-paralysis and were followed up for median of 2.2 (0.4-8.8) years. Higher mean postoperative Terzis score demonstrates symmetric and aesthetic improvements (3 ± 1.3 vs. 2 ± 1; p<0.05). Emotrics analysis showed postoperative improvements in resting and dynamic symmetry of all indices, with the majority statistically significant (p<0.003). The mean GBI was 35.19 with 17 (94.4%) patients reporting improvement, whereas one (5.6%) patient reported detriment after surgery. Two (5.4%) patients suffered complications: one haematoma and one infection. Four patients (9.8%) required revisional flap tightening. No patients requested revisional surgery for temporal hollowing or zygomatic fullness. CONCLUSIONS MTT effectively improves both subjective and objective resting and dynamic midface symmetry in a single stage. These results suggest this technique is a good alternative to temporalis tendon transfer techniques.
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Affiliation(s)
- N T Mabvuure
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK.
| | - R Pinto-Lopes
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK
| | - O Fernandez-Diaz
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK
| | - K Tzafetta
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK
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Rodrigues JN, Mabvuure NT, Nikkhah D, Shariff Z, Davis TRC. Minimal important changes and differences in elective hand surgery. J Hand Surg Eur Vol 2015; 40:900-12. [PMID: 25320122 DOI: 10.1177/1753193414553908] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 09/12/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Minimal important changes and differences describe the smallest changes and differences between individuals that are relevant to patients following treatment. Minimal important differences may vary between conditions, treatments and lengths of follow-up, and can be calculated in different ways. Minimal important differences for elective hand surgery were reviewed. A total of 99 minimal important differences were identified in 29 articles. The conditions, treatments, outcome measures used and follow-up periods are discussed. The Disabilities of the Arm, Shoulder and Hand had the most estimates of minimal important differences, but these varied. The methods used in the included studies were reviewed and appraised. Most minimal important differences were calculated using retrospective anchors. Future research directions in this area are suggested. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J N Rodrigues
- University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Mabvuure NT, Hey SY, Forshaw M. Recurrent respiratory distress and cardiopulmonary arrest caused by megaoesophagus secondary to achalasia. Int J Surg Case Rep 2014; 5:628-32. [PMID: 25128729 PMCID: PMC4200884 DOI: 10.1016/j.ijscr.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/20/2014] [Revised: 06/18/2014] [Accepted: 07/05/2014] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Respiratory distress and arrest from tracheal compression secondary to megaoesophagus are rare complications of achalasia. We present the case of a man with end-stage achalasia who required oesophagectomy to prevent recurrent life-threatening tracheal compression and respiratory arrest. A literature review is also presented. PRESENTATION OF CASE A 40-year old man presented with post-prandial stridor which resolved spontaneously, later being diagnosed with achalasia. He underwent pneumatic dilatation year later, intended as definitive treatment. Despite intervention, the patient had developed megaoesophagus. One month later he presented with tracheal compression and cardiorespiratory arrest but was successfully resuscitated. He subsequently underwent elective oesophagectomy. DISCUSSION Over 40 case reports of achalasia presenting with stridor have been published. However, only three cases (all female, age range, 35-79 years old) of cardiac, respiratory or cardiorespiratory arrest have been published. The definitive treatments received by these patients were botulinum toxin injections, open Heller cardiomyotomy with Dor fundoplication and pneumatic dilatation. None of these patients suffered recurrent respiratory distress following definitive treatment. The patient currently reported was unique as he suffered cardiorespiratory arrest following an intended definitive treatment, pneumatic dilatation. As such oesophagectomy was considered the greatest risk-reduction intervention. CONCLUSION Oesophagectomy should be considered for patients with end-stage achalasia and mega-oesophagus causing respiratory compromise to avoid potential fatal complications such as tracheal compression and subsequent respiratory arrest.
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Affiliation(s)
| | - Shi Ying Hey
- Lister Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Matthew Forshaw
- Lister Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
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Abstract
Colectomy with ileoanal pouch formation is usually contraindicated in patients with Crohn's disease (CD) due to the risk of recurrent disease and pouch failure. We report the case of a patient, initially thought to have ulcerative colitis (UC), who underwent such surgery but subsequently developed perianal CD. She presented with diarrhoea and weight loss. Inflammatory markers were raised. Pouchoscopy revealed deep ulcers within the pouch. The main differential diagnoses were idiopathic pouchitis and recurrent CD. However, immunohistochemical staining demonstrated positivity for cytomegalovirus (CMV). Stool frequency, C reactive protein and albumin normalised within 48 h of starting oral valgancyclovir. At 15 weeks, pouch appearances were improved, no histological evidence of CMV was found and baseline pouch function had returned. This case highlights that CD can present many years after surgery for apparent UC. Also, CMV pouchitis should be considered as a differential cause of pouchitis especially as it is treatable with antiviral therapy.
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Affiliation(s)
| | | | - Karin Oien
- NHS Greater Glasgow and Clyde, Glasgow, UK
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Mabvuure NT, Rodrigues JN, Hindocha S. Academic mentoring in surgery: Applying the near-peer principles to the training hierarchy: Including medical students. J Plast Reconstr Aesthet Surg 2014; 67:879-81. [DOI: 10.1016/j.bjps.2014.01.011] [Citation(s) in RCA: 3] [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] [Received: 12/01/2013] [Accepted: 01/12/2014] [Indexed: 11/30/2022]
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Abstract
The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes that induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Burn injuries provide an extreme model of trauma induced stress responses that can be used to study the long-term effects of a prolonged stress response. Although the stress response to acute trauma evolved to confer improved chances of survival following injury, in modern surgical practice the stress response can be detrimental.
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Affiliation(s)
- Celeste C Finnerty
- Department of Surgery, Shriners Hospitals for Children-Galveston and the University of Texas Medical Branch, Galveston, Texas
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Mabvuure NT, Griffin MF, Hindocha S. The race to residency: Publication practices of medical students interested in plastic surgery. Int J Surg 2014; 12:367-8. [DOI: 10.1016/j.ijsu.2014.01.020] [Citation(s) in RCA: 3] [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] [Received: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
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Mabvuure NT, Rodrigues J, Klimach S, Nduka C. A cross-sectional study of the presence of United Kingdom (UK) plastic surgeons on social media. J Plast Reconstr Aesthet Surg 2014; 67:362-7. [DOI: 10.1016/j.bjps.2013.12.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 11/30/2022]
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Mabvuure NT, Rodrigues JN. The reduced work hours debate in general plastic surgery journals. J Plast Reconstr Aesthet Surg 2014; 67:e131-3. [PMID: 24486149 DOI: 10.1016/j.bjps.2014.01.016] [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: 12/13/2013] [Revised: 12/27/2013] [Accepted: 01/12/2014] [Indexed: 11/18/2022]
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Agha R, Mabvuure NT, Camm C, Edison E. Improving the preoperative care of patients with femoral neck fractures through the development and implementation of a checklist. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.386] [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: 10/26/2022]
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Mabvuure NT, Rodrigues J, Cumberworth A, Mahmud M. Twelve tips for running successful junior doctor-led teaching programmes for medical students. Med Teach 2013; 35:628-632. [PMID: 23544916 DOI: 10.3109/0142159x.2013.778394] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Medical students value teaching by junior doctors and find it comparable to consultant-led teaching. Although several junior doctor-led teaching programmes have been developed, there is insufficient information in the literature to guide junior doctors planning on developing such programmes. AIM This article gives junior doctors 12 practical tips on how they might develop and run successful teaching programmes for medical students. RESULTS The 12 tips are (1) Clearly define the scope of your programme, (2) Ensure student-defined learning goals are included at an early stage, (3) Inform and involve your fellow junior doctors in teaching, (4) Plan teaching rotas in advance, (5) Learn to teach effectively by attending courses, (6) Promote your programme to medical students as widely as possible, (7) Use varied and interactive teaching methods, (8) Establish rapport with students, (9) Include assessment as part of the teaching programme, (10) Seek feedback from attendees and senior faculty, (11) Establish rules for tutorials and (12) Secure formal recognition for your scheme. CONCLUSIONS These 12 tips may help junior doctors to develop and manage successful teaching programmes. It may also be a useful guide for senior faculty advising junior doctors who aspire to establish such teaching programmes.
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Lane JC, Mabvuure NT, Hindocha S, Khan W. Current concepts of prophylactic antibiotics in trauma: a review. Open Orthop J 2012; 6:511-7. [PMID: 23248721 PMCID: PMC3522105 DOI: 10.2174/1874325001206010511] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/09/2012] [Accepted: 09/16/2012] [Indexed: 11/22/2022] Open
Abstract
Traumatic injuries cause 5.8 million deaths per year globally. Before the advent of antibiotics, sepsis was considered almost inevitable after injury. Today infection continues to be a common complication after traumatic injury and is associated with increases in morbidity and mortality and longer hospital stays. Research into the prevention of post-traumatic infection has predominantly focused on thoracic and abdominal injuries. In addition, because research on sepsis following musculoskeletal injuries has predominantly been on open fractures. There is a paucity of research into the prevention of soft tissue infections following traumatic injuries. This review analyses the evidence for the role of prophylactic antibiotics in the management of soft tissue injuries. Emphasis is placed on assessing the strength of the presented evidence according to the Oxford Level of Evidence scale.
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Affiliation(s)
- Jennifer Ce Lane
- Department of Plastic Surgery, Guy's and St Thomas's Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Mabvuure NT, Malahias M, Hindocha S, Khan W, Juma A. Acute compartment syndrome of the limbs: current concepts and management. Open Orthop J 2012; 6:535-43. [PMID: 23248724 PMCID: PMC3522209 DOI: 10.2174/1874325001206010535] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/07/2012] [Accepted: 09/19/2012] [Indexed: 11/22/2022] Open
Abstract
Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome.
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Cumberworth A, Mabvuure NT, Hallam MJ, Hindocha S. Is home monitoring of international normalised ratio safer than clinic-based monitoring? Interact Cardiovasc Thorac Surg 2012; 16:198-201. [PMID: 23143204 DOI: 10.1093/icvts/ivs454] [Citation(s) in RCA: 6] [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] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic was written according to a structured protocol, to answer the question: 'In patients taking warfarin, is home self-monitoring of international normalized ratio (INR) safer than clinic-based testing in reducing bleeding, thrombotic events and death?' Altogether, 268 papers were found using the reported search. Five papers represented the highest level of evidence to answer the clinical question (four systematic reviews with meta-analysis and one meta-analysis). The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The principal outcomes of interest were death, major haemorrhage, major thromboembolism, and time (or percentage time) spent within the therapeutic range, compared between self-monitoring/self-management and conventional management. Self-monitoring/self-management was associated with a significantly reduced risk of all-cause mortality of 26-42%. All meta-analyses reported on major thromboembolism, finding significant reductions in risk of ~50%. One meta-analysis found a 35% reduction in the risk of major haemorrhage, with the other four studies finding no significant difference. Only one study found self-monitoring/self-management to be associated with a significantly greater proportion of time within range, with another finding no significant difference in either the percentage of therapeutic results or in the time within range. The remaining two could not combine data for meta-analysis owing to methodological heterogeneity. We conclude that self-monitoring/self-management appears to be safer than conventional management. It is associated with consistently lower rates of thromboembolism and may also be associated with reduced risk of bleeding and death. This supports the updated guidance from the American College of Chest Physicians, recommending self-management of INR for patients who are both competent and motivated.
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Affiliation(s)
- Alex Cumberworth
- Brighton and Sussex Medical School, Audrey Emerton Building, Brighton, UK
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Cumberworth A, Mabvuure NT, Norris JM, Watts S. Is acupuncture beneficial in the treatment of Bell's palsy?: best evidence topic (BET). Int J Surg 2012; 10:310-2. [PMID: 22564830 DOI: 10.1016/j.ijsu.2012.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 03/19/2012] [Revised: 04/28/2012] [Accepted: 04/29/2012] [Indexed: 11/19/2022]
Abstract
A best evidence topic in facial nerve surgery was written according to a structured protocol. The question addressed was: in [patients with Bell's palsy], does [acupuncture] improve [facial nerve function and/or pain]? A total of 43 papers were identified using the reported search protocol, of which three articles represented the best available evidence to answer the clinical question. Two of these articles were review papers and together encompassed 13 primary articles. Publication details, type of study, patients studied, outcomes and results are tabulated. The two level 1 articles concluded that before firm conclusions can be drawn, better designed trials are required in order to establish whether acupuncture confers any benefit to patients with Bell's palsy. The level 2 randomised controlled trial (RCT) suggested that two methods of acupuncture were associated with significant improvements in pain in Bell's palsy, although the trial was poorly controlled and had risk of bias. Therefore, the clinical bottom line is that until well designed trials are able to clearly demonstrate a role for acupuncture in Bell's palsy, its efficacy should be considered to remain unproven.
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Mabvuure NT. Low medical student publishing rates: lack or opportunity or initiative? Med Teach 2012; 34:254-255. [PMID: 22364461 DOI: 10.3109/0142159x.2012.652712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
BACKGROUND Medical students claim to have inadequate opportunities to conduct research, whilst some do not know how to make the initial steps. There is a need for medical educators to not only direct students to research opportunities but also to counsel them on the attitudes required for the student's success in a research environment. AIM This article gives educators 12 tips on guidance that might help motivated medical students when starting their research careers. The various opportunities for students to participate in research are also identified. METHOD Tips were devised from personal experience and a review of the literature. RESULTS The 12 tips are: (1) Educate students on the benefits of research. (2) Encourage students to take the initiative to create opportunities for themselves. (3) Encourage students to undertake extracurricular research. (4) Encourage students to network with other researchers. (5) Encourage students to engage with student-selected components of their courses. (6) Encourage students to apply for summer research programmes. (7) Encourage students to attend scientific conferences. (8) Advise students to consider intercalated degrees. (9) Encourage students to do research during elective placements. (10) Make students aware of the MBPhD courses. (11) Emphasise research as a learning process and reduce focus on output. (12) Advise students to balance their academic and research interests. CONCLUSIONS The 12 tips highlight important attitudes for students to take in research as well as highlighting various opportunities for research.
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