Complex intraoperative defect planning flexibility-Post-salvage laryngectomy defect reconstruction with a double skin-paddled radial forearm free flap.

Reconstruction of pharyngoesophageal defects following total laryngectomy poses a significant challenge. The goals of reconstruction are to provide alimentary tract continuity and to restore speech and swallowing functions. Patients with radiotherapy recurrent disease often have unfavourable tissue for healing with a high incidence of pharyngocutaneous fistula.

Using BTM to reconstruct a complex dorsal hand wound with segmental loss of EDC tendon: Case report and review of the literature.

We present the case of a 65 year old man who sustained a complex dorsal hand degloving injury with segmental loss of EDC tendon to middle finger, which was reconstructed using BTM. He returned to near full function despite not having a tendon reconstruction, and the uninjured tendons were able to glide without restriction beneath the BTM. We review the case and the literature surrounding the use of BTM in this clinical scenario.

Introduction of the low risk ankle rule to a paediatric emergency department.

Introduction: Ankle injuries are a common presentation to the paediatric emergency department (PED), accounting for approximately 2% of presentations. X-rays are ordered for 85-95% of patients but only 12% of x-rays reveal a fracture. Clinical prediction rules, such as The Low Risk Ankle Rule (LRAR) exist to help clinicians safely reduce the frequency of radiography in these injuries.

Don't Shoot Yourself in the Foot: Reconstruction of a Through-and-Through Gunshot Wound of the Foot.

A 69-year-old man presented with an accidental, self-inflicted, through-and-through left foot gunshot wound. An entry wound on the dorsum of the foot was noted, with a larger exit wound on the plantar aspect. X-ray revealed comminuted fractures of the second, third, fourth, and fifth metatarsals with numerous foreign bodies.

National rotavirus vaccination programme implementation and gastroenteritis presentations: the paediatric emergency medicine perspective.

Background: Throughout the developed world, the introduction of rotavirus vaccination has led to reductions in the incidence and severity of acute gastroenteritis (AGE) in young children and consequently to reductions in paediatric emergency department (PED) attendances with AGE. Rotavirus vaccination was added to the Irish National Immunisation Schedule in November 2016.

Aims: To assess the impact of vaccine introduction on citywide PED attendances and hospital admissions with all-cause AGE during rotavirus season.

Novel oral anticoagulant induced upper limb haematoma: A case report.

The development of novel oral anticoagulant agents (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban has given patients better treatment alternatives to aspirin, clopidogrel, heparin and warfarin, mainly for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF), prophylaxis/treatment of venous thromboembolism (VTE) and also for the secondary prophylaxis of acute coronary syndromes. These agents are gaining in popularity due to their more stable pharmacokinetic profile, fewer drug interactions, as well as eliminating the need for routine monitoring. NOAC induced haematomas of the upper limb are rare and there is no real consensus on management.

Opportunity Costs in Paediatric Training: The Specialist Registrars Experience.

In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression, 2) perceived functional effectiveness at work, 3) psychological impact of hospital based training, and 4) the personal and social cost of training.

Delayed Infant Subaponeurotic (Subgaleal) Fluid Collections: A Case Series of 11 Infants.

Background: Although subgaleal hemorrhage can present very soon after delivery with catastrophic consequences, subaponeurotic or subgaleal fluid collections are rare and clinically distinct causes of infant scalp swelling that present weeks to months after birth. Their exact etiology remains uncertain; however, they are frequently associated with instrumental and traumatic delivery.

Aim & Methods: To characterize 11 subaponeurotic fluid collections that presented to the Temple Street Children's University Hospital Emergency Department (TSCUHED) from July 2013 to July 2015 by a retrospective chart review.

Intranasal fentanyl for the management of acute pain in children.

Background: Pain is the most common symptom in the emergency setting; however, timely management of acute pain in children continues to be suboptimal. Intranasal drug delivery has emerged as an alternative method of achieving quicker drug delivery without adding to the distress of a child by inserting an intravenous cannula.

Objectives: We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality.

Liposuction for lower limb lipodystrophy in congenital analbuminaemia: a case report.

Congenital analbuminaemia is a very rare autosomal dominant disorder in which patients have no serum albumin and markedly low serum total protein concentration. Clinically patients present with mild oedema, hypotension, fatigue and lipodystrophy often with abnormal body habitus. With only around 50 reported cases in the literature worldwide, management of the resulting lipodystrophy remains unclear.

Poor compliance with child safety restraint use while travelling.

Road traffic accidents are a leading cause of death of children. It is the law that all children should be appropriately secured when traveling in vehicles. The aim of this study was to evaluate parental conformity with these regulations and to test if advice given at a Paediatric outpatient clinic could improve compliance.

Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades.

Objective: We sought to compare the incidence and antecedents of neonatal brachial plexus injury (BPI) in 2 different 5-year epochs a decade apart following the introduction of specific staff training in the management of shoulder dystocia.

Study Design: All infants with BPI were prospectively identified during 2004 through 2008. Injuries were correlated with maternal details and intrapartum events and compared with the earlier series.

Basal cell carcinoma presenting late in a shotgun scar.

The development of a basal cell carcinoma (BCC) as a late complication of a shotgun injury is a rare clinical entity. We report the case of a 68-year-old Caucasian man who developed a BCC at the site of a scar from a shotgun pellet entry wound that was sustained 14 years previously. We emphasize the importance of excluding malignancy in a non-healing lesion and discuss the possible etiologic factors in the development of a BCC at the site of previous trauma.

Optical coherence tomography: a potential tool for unsupervised prediction of treatment response for Port-Wine Stains.

Background: Treatment of Port-Wine Stains (PWS) suffers from the absence of a reliable real-time tool for monitoring a clinical endpoint. Response to treatment varies substantially according to blood vessel geometry. Even though optical coherence tomography (OCT) has been identified as a modality with potential to suit this need, it has not been introduced as a standard clinical monitoring tool.

Carbon dioxide laser ablation as first-line management of in-transit cutaneous malignant melanoma metastases.

Introduction: In-transit cutaneous malignant melanoma metastases remains a difficult and distressing disease. It is a sequela to the primary lesion represented by melanoma deposits between the site of excision and the draining lymph nodes. We present our experience of carbon dioxide ablation of in-transit cutaneous malignant melanoma metastases and discuss the role of laser ablation as first-line management of the disease.

Laser depilation and hygiene: preventing recurrent pilonidal sinus disease.

Background: Pilonidal sinus disease of the natal cleft is a painful and debilitating condition which often recurs despite multiple surgical undertakings. We describe the long pulsed alexandrite laser for hair depilation and the role of personal hygiene, which is often overlooked when treating this disease, as an adjunct to preventing recurrent pilonidal sinus disease.

Methods: A review of 14 patients who underwent laser hair depilation in the natal cleft following pilonidal sinus surgery.