Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial.

PURPOSE: This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). METHODS: A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours. RESULTS: A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046). CONCLUSION: This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.

Hypertelorism correction with facial bipartition and box osteotomy: does soft tissue translation correlate with bony movement?

OBJECTIVE: Hypertelorism may be corrected by either transcranial box osteotomy or facial bipartition. Despite radical bony resection, the associated soft tissue translation often seems disproportionate. The purpose of this study was to review bony and soft tissue movements in a series of 15 consecutive hypertelorism correction cases. METHODS: Two surgical residents in training independently analyzed preoperative and postoperative axial and three-dimensional reconstructed computed tomography data from 15 consecutive patients undergoing facial bipartition (n = 7) or transcranial box osteotomy correction (n = 8) between 2001 and 2010. Anterior interorbital distance, lateral interorbital distance, midpoint globe distance, and globe protrusion were measured along with intercanthal distance and palpebral fissure width. RESULTS: The mean preoperative anterior interorbital distance was 35.5 mm; postoperatively, there was a mean reduction of 9.5 mm, to 26 mm. The mean preoperative intercanthal distance was 48.1 mm; there was a mean reduction of 10.3 mm, to 37.8 mm. The mean preoperative midpoint globe distance was 69.5 mm; there was a mean reduction of 9.6 mm, to 59.9 mm. The mean preoperative globe protrusion was 17.6 mm; there was a mean reduction of 5 mm, to 12.6 mm (28.5%). The mean interclass correlation (a measurement of interrater congruency with 1 being complete agreement) was 0.85 CONCLUSIONS: Transcranial box osteotomy and facial bipartition correct hypertelorism. The medial canthal tendons, lateral canthal tendons, and globes move in proportion to the bony attachments. We observed a reduction in globe protrusion an average of 29%, therefore risking enophthalmos.