Considering the Environmental Impact of Cleft Lip and Palate Surgery.

Objective: We sought to calculate the waste generated by cleft lip and palate (CL/P) procedures and to increase awareness of the environmental impact of our speciality.

Design: Waste from 5 CL/P procedures was categorised into 5 streams and weighed. A carbon calculator tool was used to convert weight of waste in to estimated carbon emission over a 12-month period.

Safety of silver dressings in infants; a systematic scoping review.

Silver-based dressings are used to reduce infection risk and optimise conditions for wound healing. They are widely used in the management of burns and other complex wounds. However, reports of elevated serum silver and concern over systemic toxicity, has meant that their use in young children has been questioned.

Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence.

The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies.

A Systematic Review of the Efficacy of Haemostatic Interventions in Primary Cleft Palate Repair.

Objective: To evaluate the effectiveness of adrenaline infiltration, topical adrenaline, systemic tranexamic acid, fibrin tissue sealants and alginate-based topical coagulants at reducing blood loss and post-operative bleeding in primary cleft palate repair.

Design: Systematic review according to PRISMA-P guidelines, using Covidence systematic review software to facilitate 3-stage screening and data extraction by two reviewers.

Setting: Academic cleft surgery center.

NovoSorb Biodegradable Temporizing Matrix for Reconstruction of Multiplanar Degloving Injury of the Upper Limb.

Originally described as "wringer injuries" by MacCollum in 1938, traumatic multiplanar degloving injuries that occur as the result of the hand, forearm or arm being drawn between the rollers of a machine are functionally devastating and present a significant reconstructive challenge. Revascularization and comprehensive excision of devitalized bone and soft tissue, followed by appropriate skeletal fixation and vascularized soft tissue cover are the mainstays of management. To date, published case series have described local flaps and free tissue transfer for coverage of wounds that involve exposed vital structures such as nerves, vessels, and tendons.

Frailty as a predictor of adverse outcomes in head and neck reconstruction: A systematic review.

Background: Frailty has been shown to adversely impact outcomes in a number of surgical disciplines. In head and neck reconstructive surgery, frailty may represent a significant risk factor in predicting post-operative outcomes due to the common characteristics of the patient population undergoing these procedures.

Objectives: To summarize the available evidence about frailty as a predictor of post-operative complications, length of hospital stay and quality of life in patients undergoing head and neck reconstructive surgery.

The case for the pharyngeal flap pharyngoplasty in the management of velopharyngeal dysfunction.

Velopharyngeal dysfunction (VPD) occurs when there is inadequate closure of the velopharyngeal sphincter during speech. An incompetent velopharyngeal sphincter may require surgical intervention to create a functional seal between the oropharynx and the nasopharynx during speech. To date, no single pharyngoplasty procedure has emerged as superior to another, and the comparison of results between studies has been limited by variation in outcomes reporting.

Core Outcome Set for Reporting Outcomes of Interventions for Velopharyngeal Dysfunction: Final Results of the COS-VPD Initiative.

Objective: To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD.

Addition to the Toolbox of Surgical Techniques for Palatal Fistula Repair.

In response to the article by Rothermel and colleagues, the authors suggest the use of cancellous bone graft for repair of fistulae of the hard palate as an addition to the proposed toolbox.

Protocol for the development of a core outcome set for reporting outcomes of management of velopharyngeal dysfunction.

Introduction: Velopharyngeal dysfunction (VPD) is present in up to 40% of patients following cleft palate repair. Children with VPD display hypernasal speech, nasal air emission and are at a high risk for developing articulation disorders. The overall result is decreased intelligibility and acceptability of speech, as well as significant functional and social impairments.

Non-Interventional Factors Influencing Velopharyngeal Function For Speech In Initial Cleft Palate Repair: A Systematic Review Protocol.

Background: This systematic review aims to inform the development of a screening tool which pre-operatively predicts which children are likely to develop velopharyngeal insufficiency, one of the causes of poor speech outcomes, following cleft palate repair. This would be highly beneficial as it would inform pre-operative counselling of parents, allow targeted speech and language therapy, and enable meaningful comparison of outcomes between surgeons, techniques, and institutions. Currently, it is unclear which factors influence speech outcomes.

CT-guided Lung Biopsy: Effect of Biopsy-side Down Position on Pneumothorax and Chest Tube Placement.

Background Supine or prone positioning of the patient on the gantry table is the current standard of care for CT-guided lung biopsy; positioning biopsy side down was hypothesized to be associated with lower pneumothorax rate. Purpose To assess the effect of positioning patients biopsy side down during CT-guided lung biopsy on the incidence of pneumothorax, chest drain placement, and hemoptysis. Materials and Methods This retrospective study was performed between January 2013 and December 2016 in a tertiary referral oncology center.

Surgery for Velopharyngeal Dysfunction: A Systematic Review of Interventions and Outcomes.

Objective: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers.

Setting: University teaching hospital.

Experience of plastic surgery registrars in a European Working Time Directive compliant rota.

Background: Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training.

Is satisfaction with surgeon a determining factor in patient reported outcomes in breast reconstruction?

Background: Patient reported outcomes are increasingly being taken into account in planning health service provision. Few studies have examined how the process of care influences patients' perception of outcome. The aim of the current study was to quantify patient satisfaction with breast reconstruction and to examine the demographic, disease and process-of-care variables that contributed to satisfaction with breasts and overall outcome.

Patient awareness and sun protection behaviour following excision of basal cell carcinoma.

Background: Limited information is available regarding disease awareness and sun protection behaviour in patients previously treated for non-melanoma skin cancer.

Methods: Using a telephone-administered questionnaire, we investigated these characteristics in 250 patients in the west of Ireland who had undergone excision of basal cell carcinomas between January 2011 and December 2012.

Results: Only 28.

Public perception of Plastic Surgery.

Background: Public perception of Plastic Surgery is strongly influenced by the media and may not reflect the broad scope of work within the speciality. The aim of this study was to provide an assessment of the general public's perception of plastic surgical practice and to report the perceived importance of Plastic Surgery relative to other specialities working within a large tertiary referral centre.

Methods: 899 members of the public who attended our Emergency Department completed a questionnaire where they matched eight surgical specialities with 30 operative procedures and ranked the importance of 30 different hospital specialities using a Likert scale.

Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis.

The distally based sural fasciocutaneous flap is one of the few options available for local flap reconstruction of soft-tissue defects in the lower one-third of the leg. Few studies have assessed risk factors associated with poor outcomes in this flap. A literature search was performed of MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles evaluating the use of sural artery fasciocutaneous flaps for soft-tissue reconstruction of the leg.

Teaching ethics and professionalism in plastic surgery: a systematic review.

Background: Maintenance of the highest ethical and professional standards in plastic surgery is in the best interests of our profession and the public whom we serve. Both the American Board of Medical Specialties and the Accreditation Council on Graduate Medical Education mandate training in ethics and professionalism for all residents. Presently there is no gold standard in ethics and professionalism education.

Giant congenital melanocytic nevus with cartilaginous differentiation.

We report the unusual presence of a benign focus of cartilage in an excised portion of giant congenital melanocytic nevus.