Video recording of hand surgeries using a field of view (FOV) matching USB camera module and smartphone in the era of COVID-19.

BACKGROUND: As the online medium has gained in popularity due to the recent coronavirus disease (COVID-19) pandemic, video recording of surgical procedures has become crucial in medical education. Various methods for recording are available but many require professional equipment and experienced personnel. Here, we propose a feasible and acceptable method for video recording of surgeries. METHODS: An M12 mount USB camera, which is based on an Android micro-USB, was utilized. The device was purchased from a website for $32-$40. The camera was mounted between the eyes of the binocular loupes. Surgical procedures were recorded with the camera. The optimal settings were determined according to the types of surgeries. RESULTS: We recorded the following surgical procedures: radial artery superficial palmar branch (RASP) free flap harvest, carpal tunnel release, and free flap operation. The default values were retained for all settings, but the highest image quality (1080 p) was selected with an 8 mm lens. The camera battery was sufficient to record each surgery in its entirety. CONCLUSIONS: The USB camera produced high-quality videos that perfectly matched the surgeon's field of view without the need for additional staff for recording. This low-cost equipment could be widely employed for the recording of educational videos for surgeons, especially in the era of COVID 19.

Impact of chest wall perforator flap reconstruction on mastectomy in breast cancer

Introduction: Breast conserving surgery (BCS) has comparable or superior oncological safety when compared to mastectomy and is associated with improved cosmetic and psychological outcome. Previously patients with larger tumour to breast ratios were not suitable for BCS due to poor aesthetic outcomes and hence underwent total mastectomy with or without reconstruction. With the introduction of chest wall perforator flaps (CWPF), a significant proportion of these women who would have otherwise undergone mastectomy, can now qualify for BCS along with volume replacement. The objective of our study was to find out the impact of CWPFs on mastectomy and reconstruction. Methods: All patients who underwent surgery for breast cancer from January 2016 to December 2019 were included in the study to know the impact of CWPF on rates of mastectomy and other procedures. We excluded 2020-21 due to alterations in breast cancer treatment due to COVID-19 pandemic. The study was registered and approved by the local Clinical Governance department at the University Hospitals of North Midlands NHS Trust (CA12119). Results: Following the introduction of CWPF reconstruction, the mastectomy rate (including reconstruction) dropped by 10.69% (from 215 mastectomies in 2016 to 192 in 2019) and the mastectomy with reconstruction rate dropped by 23.29% (from 73 in 2016 to 56 in 2019). This change can be attributed to the use of CWPFs (from 1 in 2016 to 51 in 2019). Conclusion: CWPF reconstruction has reduced the rates of mastectomy +/- reconstruction and can potentially improve overall patient outcome.

Aesthetic Reconstruction of Auricular Keloids with a Novel Hemi-keystone Flap.

Surgical management of helical and retroauricular keloids has been rarely discussed. This study aims to introduce our successful reconstruction of helical and retroauricular keloids using a novel hemi-keystone flap. The current study is a retrospective review of patients with pathologically confirmed helical and retroauricular keloids. All keloid cases were completely excised. We covered the defect with a hemi-keystone flap followed by a single fraction of 10 Gy radiation therapy at postoperative day 0 or postoperative pressure therapy using magnets for four months. Treatment outcome was recorded as recurrence or nonrecurrence. A follow-up period of a minimum of 12 months was required in all patients. Of 45 keloids in 33 patients, none of the cases had a recurrence of their auricular keloids and the postoperative course was uneventful. We successfully reconstructed helical and retroauricular keloids using our modified hemi-keystone flaps without any keloid recurrence in one-year follow-ups. This is especially useful during the COVID-19 pandemic when facial mask wearing is mandatory. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Can volume replacement with local perforator flaps reduce the trauma to patients caused by mastectomies and cost of reconstructions in breast cancer treatment?

Aim: National reported mastectomy rate varies from 25% - 45%. Improved screening and raised breast awareness raise the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. We would like to investigate if the technique of local perforator flaps can reduce the volume of mastectomies. Method: Retrospective review of yearly breast cancer treatment operations from 2016 to 2020 in Ipswich Hospital. Results: 1367 surgical operations performed for breast cancer.In 2016,52/273(19%) patients had mastectomy and 8/273(2.9%) underwent a perforator flap operation. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed. Conclusions: Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.

Do patients regain shoulder range of movement and function in the expected timescales following DIEP reconstruction?

Keywords: Shoulder rehabilitation;Breast reconstruction;Post-operative function Purpose: Breast Reconstruction patients under the care of Plastic Surgery at NNUH are seen post-op on the ward for breathing exercises, mobilisation, shoulder and donor site exercises and discharge advice. The decision on whether patients require follow-up for shoulder range of movement is down to the physiotherapist, based on patient presentation on discharge from the ward, with patients who are not easily achieving 90 degrees of shoulder flexion and abduction receiving follow-up. The objective of this study was to see if our breast reconstruction patients were regaining good upper limb function and returning to their normal activity in the expected timescales of 12 weeks with our current pre and post-operative physiotherapy care plans, or whether they require further physiotherapy follow-up. Methods: All patients who were listed for reconstructive surgery were asked to complete the Shoulder Pain and Disability Index (SPADI) at their pre-operative appointment with the Reconstruction Specialist Nurse to give a baseline score for shoulder function. All patients received normal treatment (pre-op Breast forum, ward based care, clinic and outpatient appointment follow-up if indicated). Patients were telephoned at target of 12 weeks post op to repeat SPADI and review return to activity, work and to establish if they had any other physiotherapy related ongoing difficulties. Results: 36 patients completed pre-op SPADI, 20 patients completed pre and post op SPADIs and further assessment questions in the study period (October 2019 to March 2020). 16 patients were lost to follow up due to Covid postponing their surgery. Target for follow-up was 12 weeks, this ranged from 12 to 15 weeks. 9 patients had routine clinic follow-up based on clinical need on assessment on ward, with 1 also requiring outpatient appointments. Only 2 patients had a change in score of >18 (Threshold of minimally clinically important change). Both of these patients had IMPROVED scores post op compared to pre-op. For scores worse than pre-op, range was 0–16.1 (not clinically significant). 5 patients had not returned to their hobbies at 12 weeks, but reasons were due to ongoing chemotherapy, shielding for Covid and slow healing wounds. 11 patients had not returned to work, but not because of problems with shoulder function. 3 patients reported ongoing low back pain, 11 had sore or tight donor sites and 3 reported ongoing soreness of their breast. 1 patient reported feelings of low mood and 2 had ongoing fatigue. Conclusion(s): Patients do regain use of their upper limbs to pre-op level in expected timescale with the current treatment regime. It is not shoulder ROM that is restricting return to work or hobbies Many patients reporting tightness of donor site and, in some cases, low back pain. There may be scope for a further study to see if more Physiotherapy input for donor site exercises post-operatively can influence this. Impact: This study suggests that the current level of Physiotherapy assessment and follow up is sufficient to detect patients who will benefit from ongoing therapy. Funding acknowledgements: Not funded.

Can volume replacement with local perforator flaps reduce the trauma to patients caused by mastectomies and cost of reconstructions in breast cancer treatment?

Aims: Improved screening and raised breast awareness raises the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. Can the “relative new” technique of local perforator flaps, reduce the volume of mastectomies (and subsequently reconstructions) in a District General Hospital? Methods: Retrospective review of yearly breast cancer treatment operations from 2017 to 2020 in Ipswich Hospital. Results: 1094 surgical operations performed for breast cancer. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed. Conclusions: Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.

Breast reconstruction with immediate autologous free tissue transfer in a peri-operative COVID-19 positive patient: A case report illustrating feasibility of aftercare.

Globally, there has been a measured response to rationalise elective operating during the Coronavirus disease 2019 (COVID-19) pandemic. In terms of breast cancer care, this has led to a restricted provision of reconstruction with autologous free tissue transfer. A primary concern is the risk of mortality in elective surgery patients who develop COVID-19. The aim of this report is to describe the observed physiological impact of the virus on our patient, and to address how outpatient care after autologous free tissue transfer can be delivered to COVID-19 positive patients. In March 2020, we performed a bilateral breast reconstruction with a deep inferior epigastric perforator flap and a superficial inferior epigastric perforator flap. The patient became symptomatic on day three post-operatively, tested positive for COVID-19 and was discharged home. Drain and dressing management was continued through the use of telemedicine. Two weeks following the operation, a breast seroma formed that was drained semi-electively in the COVID-19 positive area of the Emergency Department. The patient visited the dressing clinic twice in total and healed after three weeks. Despite undergoing complex surgery and having pre-operative chemotherapy, our patient suffered a mild form of the virus limited to upper respiratory symptoms. Physiologically we did not see any significant difference to that of the normal post-operative course. This case demonstrates the possibility of managing autologous breast reconstruction patients using telemedicine. Although COVID-19 can complicate, or even be fatal, in the perioperative course, our patient thankfully suffered no discernable negative outcome from her infection.