The Value of Auditing Surgical Records in a Tertiary Hospital Setting.

BACKGROUND: Assessing and improving quality of care should be of paramount importance to health care systems and providers. This study aimed to evaluate the quality of surgical records at the Jordan University Hospital. METHODS: We used the previously validated Surgical Tool for Auditing Records (STAR) to retrospectively evaluate the quality of surgical records of patients who underwent surgery in the general surgery department from 2016 to 2021. Total STAR and section-specific STAR scores were compared using the two independent sample Student's ttest on SPSS Statistics, version 23 (IBM Corp, Armonk, NY). RESULTS: A total of 488 records were selected and evaluated using the STAR. The total STAR scores significantly improved steadily throughout the years compared to the baseline in 2016, reaching the highest in 2021. All domains had improved compared to the baseline except for anesthesia records that did not change from an already high baseline. The highest improvements between STAR domains were observed in Initial Clerking and Consent domains. CONCLUSION: Our study demonstrates that significant improvements in the quality of surgical records can be achieved by simply using an electronic record entry system, personnel education, and systematic auditing.

Impact of Parental Consanguinity on the Frequency of Orofacial Clefts in Jordan.

ABSTRACT: Orofacial clefts (OFCs) are the most common craniofacial congenital anomalies, and its prevalence is highest among Asian populations. The aim of this retrospective case-control study is to evaluate the effect of parental consanguinity on the frequency of OFCs at Jordan University Hospital over a 15-year-period. The study group consists of all patients with OFCs presented to the major tertiary referral center in Jordan during the last 15 years, along with age and gender-matched controls. The authors analyzed the risk of different predictors, including consanguinity, on the development of OFCs, both cleft lip with or without cleft palate (CL/P) and cleft palate only. A total of 332 participants were included in this study, with a mean age of 74.36 (±48.75) months. The authors included 129 (38.9%) OFCs, and 203 (61.1%) controls. The percentage of parental consanguinity among OFCs group was 41.1%, compared to only 24.1% for controls, a difference that was statistically significant (P = 0.001). On logistic regression analysis, the authors found that parental consanguinity is a significant predictor for the occurrence of OFCs (P = 0.007), where people with consanguineous marriage have 2 times higher risk (odds ratio of 0.504, with 95% confidence interval 0.306-0.830) to have offspring with OFCs. Moreover, lower birth weight babies are also significantly more associated with OFCs (P = 0.014), with an odds ratio of 1.819 (95% confidence interval 1.131 2.926). Among the Jordanian population, the authors found that consanguinity and lower birth weight were the only variables significantly associated with the development of OFCs.

Impact of plastic surgery medical training on medical students' knowledge, attitudes, preferences, and perceived benefits: Comparative study.

INTRODUCTION: Misconceptions surrounding the discipline of plastic surgery are widespread among not only the public, but medical students and professionals, as well. The purpose of this study was to explore how the inclusion of plastic surgery rotation into the medical curriculum affects medical students' knowledge, attitudes and preferences regarding plastic surgery specialization and referral.   Design and Methods: A descriptive-correlational design was utilized to collect data from 200 medical students in the final two years of education from two separate six-year medical programs in Jordan. Data was collected using self-reported questionnaires regarding knowledge of surgical procedures allocation, attitude towards plastic surgery, preference of specialization, and benefits of plastic surgery to physicians and patients. RESULTS: Analysis showed that medical students of plastic surgery integrate rotation (program A) had a higher average score of correct procedure-allocation (M = 12.57, SD = 3.14), compared to non-integrated plastic survey rotation program (program B) (M = 8.29, SD = 3.05) 8.29. About 83% of students in program A had their knowledge on plastic surgery from direct exposure to a plastic surgeon, compared to 43% of program B, and 24% of students in program A reported that their perception of plastic surgery influenced by media compared to 62% of those in program B. CONCLUSIONS: medical students who have been exposed to plastic surgery education are more confident about procedures of plastic surgery specialty and had more reliable sources of knowledge about plastic surgery than those who were not exposed to plastic surgery rotation.

Reconstruction of Upper Extremity Defects by Random Pedicle Abdominal Flaps: Is It Still a Valid Option?

Traumatic soft tissue defects of the hand and upper extremities are common and may be challenging to the reconstructive surgeon. Several reconstructive procedures such as use of local, regional, distant, and free flaps have been described. This study aimed to report the techniques, outcomes, and complications of pedicle abdominal flaps in reconstructing hand and upper extremity defects. METHODS: In this retrospective study, we included patients with different traumatic defects in the hand and upper extremities who underwent reconstruction by random pedicle abdominal flaps between 2002 and 2017 at Jordan University Hospital, Jordan. Data were collected and analyzed, and the variables studied included patient age and sex, etiology and size of the defect, complications, outcomes, and the need for further revision procedures. Appropriate statistical analysis was used to examine the potential factors affecting flap survival. RESULTS: We included a total of 34 patients with a mean age of 22.2 years, ranging from 1 to 54 years. Finger degloving was seen in approximately half of the patients. Flap survival rate was 85.3%. A small area of defect was the only risk factor that significantly affected the flap failure rate. CONCLUSIONS: Thin pedicle abdominal flaps are a valid, affordable, and safe option in upper extremity traumatic defects, especially in situations where microsurgical techniques are unavailable or contraindicated. Extra care should be taken when the defect surface area is small.

Prednisolone-induced virginal mammary hypertrophy: Case report.

INTRODUCTION: Virginal mammary hypertrophy (VMH) is a rare benign disorder of the breast characterized by excessive enlargement of one or both breasts. It usually presents during adolescence. Drug-induced VMH has been scarcely reported in case reports. Review of the literature showed that prednisolone-induced gigantomastia was reported in a single study on a 47-year-old female. In this study, a case of VMH in a 17-year-old girl following prednisolone treatment will be described. Clinical presentation, clinical findings, diagnostic work-up, management and follow up are discussed. PRESENTATION OF CASE: A 17-year-old, single female presented to the plastic surgery department at our institute with progressive enlargement of both breasts, 2 months following treatment with prednisolone. Incisional biopsy excluded other breast differential diagnoses. The patient was managed surgically with bilateral mammaplasty with free nipple-areola graft. A total of 8.325 kg of breast tissue was resected. Follow-up 48 months postoperatively revealed good patient satisfaction with no recurrence of breast hypertrophy. DISCUSSION: Although the estrogen theory is regarded as the most credible explanation for VMH, several cases of drug-induced mammary hypertrophy have been reported. This study may be the first reported case of adolescent prednisolone-induced VMH. Mammaplasty is an accepted treatment despite its possible association with a higher recurrence rate. CONCLUSION: VMH may be a rare complication of prednisolone treatment. It should be considered in patients presenting with breast hypertrophy following steroid administration.

Fasciocutaneous Flap Reconstruction after Repair of Meningomyelocele: Technique and Outcome.

AIMS: The objectives of this study are to describe our technique in meningomyelocele (MMC) repair, analyzing the results and complications, as well as to study the effect of delay in operation on the complication rate. PATIENTS AND METHODS: Between March 1997 and October 2012, 48 patients with MMC were treated at Jordan University Hospital by a combined neurosurgical and plastic surgical team. Patients underwent neurosurgical repair of the neural elements and soft tissue reconstruction using local fasciocutaneous flaps. The patients were further divided into two subgroups (local or referrals from other hospitals). RESULTS: Of all patients, 8 (16.6%) had postoperative complications. When the complication rate was compared between the two groups, in the first group, who had early repair, only 2 out of 19 patients had complications (10.5%), while in the second group, with delayed operation, 6 out of 29 patients developed complications (20.7%). The follow-up of all patients showed that the soft tissue cover maintained good durability with no skin breakdown. CONCLUSION: We recommend early MMC repair using this rather simple method to provide a reliable soft tissue coverage. A combined approach by a neurosurgical and plastic surgical team in the management of this challenging neonatal emergency is appreciated.

Functional and esthetic assessment of radial forearm flap donor site repaired with split thickness skin graft.

The purpose of this study was to evaluate the long-term functional and esthetic outcomes of radial forearm flap (RFF) donor site repaired with split thickness skin graft (STSG). Nineteen patients underwent surgical reconstruction of oro-facial defects by the use of RFF and their donor sites were reconstructed with STSG. The patients were followed up at least for 12 months postoperatively and the left hand was the non-dominant hand in all of them. Objective methods including pinch strength, grip strength, range of motion, current perception threshold (CPT) and two-point discrimination, and subjective methods including patients interview, visual analogue score (VAS) about function, sensitivity, pain and color match, were collectively employed for donor site assessment. Our data revealed some degree of reduction in motor function and sensation compared to the non-donor hand. The difference of pinch strength means was 9.81% and of the grip strength was 12.6%. The difference of wrist flexion means was 17.6% and of wrist extension was 13.4%. However, none of the patients had functional defects of forearm supination and pronation, wrist ulnar deviation or wrist radial deviation. Subjective evaluation showed that the donor site repaired with STSG was well accepted by the patients particularly from a functional point of view. These results demonstrate that STSG represents a favorable choice for RFF donor site repair.

Complete subtalar release for older children who had recurrent clubfoot deformity.

BACKGROUND: Neglected idiopathic clubfoot deformities, and severe recurrent deformity after previous surgery presents technical difficulties for correction and challenges for surgeons to achieve primary skin closure. METHODS: Between 2000 and 2006, 18 children (30 feet), had complete subtalar release (CSTR) for failed previous surgery in 28 feet and severe neglected congenital talipes equinovarus (CTEV) in 2 feet followed by cross leg fasciocutaneous flaps for reconstruction of residual defect at the ankle and foot after full correction of the deformity. Mean patients followed up were 4.5 years (average 2-8 years). 23 feet were classified as Dimeglio III and 7 feet as Dimeglio IV. RESULTS: All cases achieved a plantigrade foot, better walking ability (p<0.03), and parental satisfaction with the result (p<0.001). Ankle joint doriflexion increased from mean (-21.33 degrees ) preoperatively to (12.5 degrees ) postoperatively. All cases showed postoperative improvement in their radiographic findings. The mean preoperative talocalcaneal angle increased from (15.7 degrees to 30.03 degrees ). The talo-first metararsal angle improved from a preoperative mean of -16 degrees mean of 5.53 degrees postoperatively. At the final follow-up cosmetically acceptable plantigrade foot was achieved in all feet. Four legs (14.28%) developed hypertrophic scars at the donar flap site. One patient developed 1.5cm marginal necrosis of the flap, which did heal after debridement by secondary intention. None of the feet had recurrence at the final follow up. Despite the enormous improvement clinically and radiologically, their was no statistical significant difference between preoperative and postoperative radiological angles (p<0.069). The number of previous surgical interventions had no influence on the outcome. All the previously treated feet had inadequate release of important tethered soft tissue. CONCLUSION: This is indicative of the enormous value of complete subtalar release combined with cross leg fasciocutaneous flap without the need for bony intervention in previously operated failed feet or neglected deformities.

Tbx22 expressions during palatal development in fetuses with glucocorticoid-/alcohol-induced C57BL/6N cleft palates.

T-box transcription factor 22 (Tbx22) belongs to the T-box family of transcription factors and was originally found using an in silico approach to identify new genes in the human Xq12-Xq21 region. Mutations in Tbx22 have been reported in families with X-linked cleft palate and ankyloglossia, but the underlying pathogenetic mechanism remains unknown. The aim of this study was to evaluate the expression of Tbx22 messenger RNA (mRNA) during palatogenesis in glucocorticoid-/alcohol-induced cleft palate in a C57BL/6N mouse model. Palatal development was monitored by histomorphologic and immunohistochemical studies and by in situ hybridization. Thirty pregnant C57BL/6N mice at 8 weeks of age, weighing 20 to 25 g, were used in this study. In the experimental group, 12 mice were exposed to alcohol for 7 days before mating, and 12 mice in the control group were not exposed. Six mice in a sham group were exposed to neither alcohol nor glucocorticoids. A total of 18 fetuses with induced cleft palates each from 102 fetuses in the experimental group, 109 in the control group, and 58 in the sham group were used. In both the experimental and the control groups, glucocorticoids were injected subcutaneously on gestational days (GD) 9.5, 10.5, and 11.5, and each mouse was killed on GDs 10.5 to 15.5. Histomorphologic findings were studied using hematoxylin and eosin staining, and antibodies against proliferation cell nuclear antigen, matrix metallopeptidase 9, zinc finger protein 422 (Krox25) heat shock protein 70, and Tbx22 were used in immunohistochemical analysis. Mouse Tbx22 mRNA was identified, and its expression was analyzed during embryogenesis by polymerase chain reaction and in situ hybridization. Coronal sections of the cleft maxilla of the embryos with induced cleft palates had a gap between the palatal shelves, where 2 palatal shelves had fused as in normal development but failed to meet and fuse to each other. By in situ hybridization, Tbx22 mRNA was found to be expressed in distinct areas of the head, such as the mesenchyme of the inferior nasal septum, the posterior palatal shelf before fusion, and the attachment of the tongue during normal development of the palate and maxilla from GD 11.5. Localization in the tongue frenum correlated with the ankyloglossia phenotype in the induced cleft palate animal model.