Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience.

Background: Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures.

Idiopathic carpal tunnel syndrome in children and adolescents.

Purpose: A retrospective review of a single institution's experience with idiopathic carpal tunnel syndrome (CTS) in children and adolescents was performed to evaluate management and outcomes in an effort to establish a treatment protocol.

Methods: All patients diagnosed with idiopathic CTS from ages 1 to 16 years of age between 1983 and 2013 were reviewed. The results of diagnostic testing and efficacy of therapeutic interventions were analyzed.

Enhanced recovery after surgery in microvascular breast reconstruction.

Background: Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery, but they have not been described for patients undergoing microvascular breast reconstruction.

Study Design: A standardized ERAS pathway was developed through multidisciplinary collaboration which addressed all phases of surgical care for patients undergoing free-flap breast reconstruction using an abdominal donor site. Two surgeons used the ERAS pathway, and results were compared with a historical cohort of the same 2 surgeons' patients treated by traditional care after surgery (TRAS).

Trans-vastus Intermedius Transfer of the Pedicled Anterolateral Thigh Flap for Posterior Thigh Reconstruction.

Proximal, posterior thigh wounds from oncologic or traumatic defects can be difficult wounds to reconstruct if local flap options have been sacrificed during the trauma or oncologic resection. Free flap options to cover these defects are also difficult because of the lack of convenient recipient vessels in the region. The authors present 2 cases (oncologic and traumatic) wherein a myocutaneous anterolateral thigh (ALT) flap was harvested and tunneled from the anterior muscle compartment to the posterior muscle compartment of the thigh through a medially based transmuscular tunnel, decreasing the required pedicle distance to the wound.

A fast-track recovery protocol improves outcomes in elective laparoscopic colectomy for diverticulitis.

Background: Fast-track (FT) postoperative protocols have been shown to be highly beneficial in open colectomy. Some have questioned the necessity of an FT protocol in the setting of laparoscopic colectomy because hospital stays are short and morbidity is low compared with open surgery. We set out to determine whether an FT protocol has any utility in the setting of elective laparoscopic colectomy.

Temporal and postural variation of 12-lead high-frequency QRS electrocardiographic signals in asymptomatic individuals.

Because changes in the 12-lead high-frequency QRS electrocardiogram (HF QRS ECG) more sensitively identify myocardial ischemia than do changes in the ST segments of the conventional ECG, it is important that changes in HF QRS signals that are merely physiological be distinguishable from those that are potentially pathological. We therefore studied the temporal variation of HF QRS measures such as root mean square (RMS) voltage and the presence vs absence of reduced amplitude zones (RAZs) in 107 asymptomatic individuals in the supine position during a brief period of ECG monitoring. In addition, to ascertain the effects of posture on the 12-lead HF QRS ECG, we collected additional seated data from 25 of these individuals and estimated the fifth and 95th percentile of the percent relative change between the supine and seated measurements.

Month-to-month and year-to-year reproducibility of high frequency QRS ECG signals.

High frequency electrocardiography analyzing the entire QRS complex in the frequency range of 150 to 250 Hz may prove useful in the detection of coronary artery disease, yet the long-term stability of these waveforms has not been fully characterized. Therefore, we prospectively investigated the reproducibility of the root mean squared voltage, kurtosis, and the presence versus absence of reduced amplitude zones in signal averaged 12-lead high frequency QRS recordings acquired in the supine position one month apart in 16 subjects and one year apart in 27 subjects. Reproducibility of root mean squared voltage and kurtosis was excellent over these time intervals in the limb leads, and acceptable in the precordial leads using both the V-lead and CR-lead derivations.