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McDonnell AM, Barra ME, Abreu LA, Thornhill TS, Katz JN, Ghazinouri R. Short-Term Surgical Missions: Role of Pharmacist Volunteers. J Pharm Pract 2021; 34:838-843. [PMID: 32613876 DOI: 10.1177/0897190020934296] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care professionals often participate in short-term surgical missions in underserved areas of the world. Surgical missions often rely on the use of medications to provide health care to these underserved areas in patients with multiple comorbid conditions. The direct role a pharmacist may have in surgical missions is not well described in the literature; however, numerous opportunities exist for pharmacist involvement to improve patient care and operational processes throughout medication planning and delivery of surgical missions. Pharmacists have specialized knowledge in medication acquisition, preparation, and distribution that result in a unique position to contribute positively to the mission's clinical and operational dynamics. Pharmacists may assist in various activities such as medication ordering, accrual, purchasing and preparing during the surgical mission. Pharmacists may also provide clinical support and offer alternative medications in the setting of drug intolerance or allergies. In 2008, Operation Walk Boston, a short-term surgical mission was established to provide hip and knee joint replacements to patients in the Dominican Republic. Pharmacists and pharmacy residents play a crucial role as members of this surgical mission. Based on our experience, this article aims to describe the evolving role of pharmacists as a member of a surgical mission.
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Affiliation(s)
- Anne M McDonnell
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Luis Alcantara Abreu
- Surgical Net Orthopedics, Punta Cana Health Center, Punta Cana, Dominican Republic
| | - Thomas S Thornhill
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey N Katz
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Roya Ghazinouri
- Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
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Luginbuhl A, Kahue CN, Stewart M, Curry JM, Weed D, Zender C, Netterville J, Zafereo M. Head and neck surgery global outreach: Ethics, planning, and impact. Head Neck 2021; 43:1780-1787. [PMID: 33586258 PMCID: PMC8248027 DOI: 10.1002/hed.26643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/19/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 01/28/2023] Open
Abstract
Background Head and neck surgical oncology and reconstruction are uniquely suited to address burdens of disease in underserved areas. Since these efforts are not well known in our specialty, we sought to understand global outreach throughout our society of surgeons. Methods Survey distributed to members of the American Head and Neck Surgery involved in international humanitarian head and neck surgical outreach trips. Results Thirty surgeons reported an average of seven trips to over 70 destinations. Identification of candidates, finances, on‐site patient care, complications, long‐term post‐surgical care, ethics, and educational goals are reported. We report a success rate of 90% on 125 free flaps performed in these settings. Conclusions The effort to answer the call for alleviating the global burden of surgical disease is strong within our specialty. There is a shared focus on humanitarian effort and teaching. Ethics of high resource surgeries such as free flap reconstruction remains controversial.
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Affiliation(s)
- Adam Luginbuhl
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Charissa N Kahue
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Matthew Stewart
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Donald Weed
- Department of Otolaryngology - Head and Neck Surgery, University of Miami Health System, Florida, USA
| | - Chad Zender
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - James Netterville
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Solano MA, Ramcharran KK, Jones LC, Sterling RS, Samaroo DR, Khanuja HS. Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge, Anxiety, and Informed Consent. J Arthroplasty 2020; 35:2410-2417. [PMID: 32451279 DOI: 10.1016/j.arth.2020.04.084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/03/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty. METHODS A team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05. RESULTS Seventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047). CONCLUSION On this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.
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Affiliation(s)
- Mitchell A Solano
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - David R Samaroo
- Department of Orthopaedic Surgery, Georgetown Public Hospital, Georgetown, Guyana
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Jayawardena ADL, Ghersin ZJ, Mirambeaux M, Bonilla JA, Quiñones E, Zablah E, Callans K, Hartnick M, Sahani N, Cayer M, Hersh C, Gallagher TQ, Yager PH, Hartnick CJ. A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience. Otolaryngol Head Neck Surg 2020; 163:971-978. [PMID: 32600113 DOI: 10.1177/0194599820935042] [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] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. STUDY DESIGN Consecutive case series with chart review. SETTING This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. METHODS Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. RESULTS A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. CONCLUSION This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Zelda J Ghersin
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcos Mirambeaux
- Department of Otolaryngology, Roberto Reid Cabral, Santa Domingo, Dominican Republic
| | - Jose A Bonilla
- Department of Otolaryngology, Benjamin Bloom Hospital, San Salvador, El Salvador
| | - Ernesto Quiñones
- Hospital de los Valles, Universidad San Francisco de Quito, Quito, Ecuador
| | - Evelyn Zablah
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin Callans
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Marina Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nita Sahani
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Makara Cayer
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Cheryl Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Thomas Q Gallagher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Phoebe H Yager
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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5
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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Abstract
Background Surgical volunteer mission is a well-recognized approach for reducing the burden of surgical disease worldwide. The aim of this study was to evaluate safety and patient satisfaction of thyroid surgery in the context of surgical mission carried out in Bohol Province, Philippines. Methods This was a prospective study involving consecutive patients undergoing thyroid surgery in the surgical mission held in 2018. Informed consent was obtained from the patients. Safety defined as observed serious postoperative complication rate as compared to its expected based on American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was the primary endpoint, whereas patient satisfaction rated on a 5-point Likert scale was the secondary endpoint. Expected serious complication rate was calculated using the surgical risk calculator of NSQIP. Thyroid surgery included partial resections, hemi-, subtotal, and total thyroidectomies. Results Thirty-eight patients underwent thyroidectomy performed by 4 surgeons in 2018 mission. Mean age of the patients was 40.6±11.3 years. Male to female ratio was 2:36. Goiter was the indication for surgery in 33 (86.8%) patients, whereas 5 (13.2%) patients were operated for thyroid malignancy. Postoperative serious complication and reoperation occurred in 1/38 (2.6%) for hematoma on first postoperative day. Expected and observed serious complication rates did not differ (1.1% vs. 2.6%; P=0.385). Ninety-seven percent of patients were satisfied with outcomes of surgery. Conclusions This prospective cohort study found thyroid surgery performed within a surgical mission to be safe. Patient satisfaction rate was 97%. Further research is needed to develop and validate patient satisfaction assessment tools in surgical missions.
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Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.,Operation Giving Back Bohol, Philippines
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Mohd Zain MR, Shamsuddin AM, Mamat AZ, Mokhtar AM, Ali S, Chen YC, Corno AF. Humanitarian Mission in Pediatric Cardiothoracic Surgery: A Recipient's Perspective. Front Pediatr 2019; 7:230. [PMID: 31231625 PMCID: PMC6568032 DOI: 10.3389/fped.2019.00230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: Pediatric cardiac surgical mission programs are deemed as common practice, especially in developing nations funded by international non-governmental organizations (NGOs). This article presents and discusses the results and strategies implemented by this partnership, aiming at achieving the autonomy of the local center by this collaboration. Materials and Methods: A retrospective review was conducted on patients with congenital heart disease who underwent surgical intervention from the beginning of the NGO collaboration (September 2015) until November 2018 in an existing cardiac center. In between those visits, any congenital heart disease patient with Risk Adjustment Congenital Heart Surgery (RACHS)-1 Category 1-3 would be discussed in a local multi-disciplinary meeting with regards to the feasibility of the surgery being performed by the local members. Results: A total of 60 operations were performed during the trips. Throughout the visit, 46% (28) of the operations were performed by the local surgeon, with or without assistance from the visiting surgeon. Between September 2015 and November 2018, 27 cases were also performed by the local team independently. For the 27 cases performed by the local team independently, the median age of the patient was 42 days (ranging from 14 days to 20 years old), with median body weight of 3.2 kg (ranging from 2.8 to 64 kg). Conclusion: Humanitarian pediatric cardiac surgical missions are safe to be done for the population in need. In order to achieve autonomy, continuous efforts by both teams are crucial, as the cooperation by the two parties ensures that the objectives are achieved.
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Affiliation(s)
- Mohd Rizal Mohd Zain
- Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Ahmad Mahir Shamsuddin
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Cardiothoracic Unit, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Ahmad Zuhdi Mamat
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Cardiothoracic Unit, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Ariffin Marzuki Mokhtar
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Department of Anesthesia, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Saedah Ali
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Department of Anesthesia, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Yen Chuan Chen
- Cardiothoracic Surgery Department, Sabah Heart Centre, Queen Elizabeth Hospital II, Kota Kinabalu, Malaysia
| | - Antonio F Corno
- East Midlands Congenital Heart Center, Glenfield Hospital, Leicester, United Kingdom.,Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom
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Chuang C, Azurdia J, Asuzu D, Ragins KT, Tomany K, Islam S, Williams S, Safanda J, Thomson JG. Functional and Quality of Life Outcomes of a Hand Surgery Mission to Honduras. Hand (N Y) 2018; 13:305-312. [PMID: 28452578 PMCID: PMC5987978 DOI: 10.1177/1558944717704515] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: The objective of this study was to assess functional, quality of life, and satisfaction outcomes of a hand surgery short-term surgical mission (STSM) to Honduras, and determine whether patient demographics and surgery characteristics during a surgical mission correlate with outcome. Methods: A total of 63 patients who received upper extremity surgery at a week-long hand surgery STSM to Honduras in March 2013 participated in the study. A before-after study design was used. Before receiving surgery, participants completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the Short Form 12 Health Survey version 2 (SF12v2). Four months postoperatively, participants completed the QuickDASH, SF12v2, and Satisfaction Survey. Results: The mean QuickDASH score significantly improved preoperatively to postoperatively. Demographics measures of age, sex, education, and income did not correlate with QuickDASH scores. Preoperative QuickDASH statistically significantly correlated with surgery type: Carpal tunnel patients had the highest scores (worst functioning). Postoperatively, mass excision and scar contracture/skin graft patients were correlated with the lowest scores. Carpal tunnel and tendon surgery patients showed greatest correlation with QuickDASH improvement. SF-12 scores revealed improvements in mental domains and declines in physical domains. Conclusions: Hand surgery performed during STSMs can result in significant functional improvement, regardless of socioeconomic status. Patients benefited from both simpler and more complex operations. Four months after surgery, general health-related quality of life measures showed improved mental indices. Measured physical indices declined despite improved QuickDASH scores. This may be due to the early general postoperative state. Further outcome research in STSMs in additional countries and specialties is required to expand our conclusions to other STSM contexts and guide best practices in STSMs.
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Affiliation(s)
| | | | | | | | - Kevin Tomany
- Merrimack Valley Orthopedic Associates,
Chelmsford, MA, USA
| | | | | | - John Safanda
- The Permanente Medical Group, San
Rafael, CA, USA
| | - J. Grant Thomson
- Yale University, New Haven, CT,
USA,J. Grant Thomson, Professor of Plastic
Surgery, Director, Yale Hand & Microsurgery Program, Section of Plastic and
Reconstructive Surgery, Department of Surgery, School of Medicine, Yale
University, PO Box 208041, New Haven, CT 06520, USA.
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Heidekrueger PI, Thu M, Mühlbauer W, Holm-Mühlbauer C, Schucht P, Anderl H, Schoeneich H, Aung K, Mg Ag M, Thu Soe Myint A, Juran S, Aung T, Ehrl D, Ninkovic M, Broer PN. Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair. J Neurosurg Pediatr 2017; 20:334-340. [PMID: 28731403 DOI: 10.3171/2017.5.peds1762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/06/2022]
Abstract
OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.
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Affiliation(s)
- Paul I Heidekrueger
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich.,Center of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon
| | | | | | - Philippe Schucht
- Department of Neurosurgery, Yangon General Hospital, Yangon.,Department of Neurosurgery, University Hospital Inselspital and University of Bern, Switzerland
| | - Hans Anderl
- Department of Plastic and Reconstructive Surgery, Innsbruck University Hospital, Innsbruck, Austria; and
| | - Heinrich Schoeneich
- Department of Plastic and Reconstructive Surgery, Interplast Germany, Section Munich
| | - Kyawzwa Aung
- Department of Neurosurgery, Mandalay University Hospital, Mandalay, Myanmar
| | - Mg Mg Ag
- Department of Neurosurgery, Yangon General Hospital, Yangon
| | | | - Sabrina Juran
- Population and Development Branch, Technical Division, United Nations Population Fund, New York, New York
| | - Thiha Aung
- Center of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - Denis Ehrl
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich
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10
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Abstract
OBJECTIVES/HYPOTHESIS To determine the safety and effectiveness of pediatric tympanoplasty performed on short-term international medical missions. STUDY DESIGN Prospective observational study. METHODS Ethiopian children who had dry or nearly dry tympanic perforations and bilateral conductive hearing losses underwent postauricular tympanoplasties with underlain temporalis fascia grafts. Pre- and postoperative air and bone audiometry was performed. Complications, graft success, hearing improvement, and dry ear at 6-month follow-up were evaluated. RESULTS Patients were 7 to 25 years old (24 female ears, 20 male ears). The majority had subtotal perforations. Operative findings included ossicular erosions and fixation by hypertrophic mucosa. There were no major medical complications or deaths in this series. Of 44 ears, 27 had complete pre- and postoperative audiometric data. Twenty-four of 44 surgeries resulted in an intact tympanic membrane. Twelve of 44 markedly reduced the perforation. Eight of 44 grafts failed. The mean improvement in PTA was 14 dB (range = -6-45 dB). Human immunodeficiency virus (HIV)+ patients had a high rate of graft failure (3/4) and comprised 38% (3/8) of complete graft failures (P = .015). Among the 20 ears with residual perforations, 14 were dry at 6-month follow-up. Of the six ears with drainage, three were HIV+ (P = .019). CONCLUSIONS Pediatric tympanoplasty is a safe procedure in a short-term surgical mission setting when high anesthetic and surgical standards are maintained. Surgical results were similar to those found in developing-world university hospitals, but were worse than in United States or European series. HIV+ children did worse than their HIV-/unknown peers, with a high rate of graft failure and persistent otorrhea. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1464-1469, 2016.
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Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head & Neck Surgery.,Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Abebe Melaku
- Department of Otolaryngology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
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