Microvascular anastomotic arterial coupling: A systematic review.

INTRODUCTION: There are several reasons microsurgeons may not use a coupler device in arterial anastomosis: may be thick-walled, non-pliable due to atherosclerotic calcification or present vessel geometrical discrepancies. This review summarises the current applications, efficacy and troubleshooting of microvascular coupler devices in arterial end-to-end anastomosis. METHODS: A systematic review of the literature was performed in November 2020 across 4 electronic databases and in accordance with the PRISMA guidelines. All studies comprised the data synthesis that reported the use of a microvascular coupler device for arterial end-to-end anastomosis. Data were extracted and collected in three groups of standardised variables: study, anastomosis-related and technical characteristics. RESULTS: Out of the 7,690 articles identified, 20 were included in the final data synthesis. Included studies involved a total of 1639 patients, who underwent 670 arterial and 1,124 venous anastomoses. Out of all arterial anastomoses, 351 were performed in free tissue transfers in head and neck, 117 in breast, 4 in upper extremity and 5 in lower extremity reconstruction, whereas the remaining were not specified. The total arterial coupler anastomosis success rate reported was 92.1% (617/670). Fifty-three (8%) arterial anastomoses were reported to result in either troubleshooting events or intra- or post-operative failures, most being reported in extremity reconstructions. CONCLUSIONS: Arterial coupling is not widespread with predominant use in head and neck and chest reconstructions, and total reported efficacy of 92.1%. Microsurgeons are reluctant to routinely use current widespread coupler devices as a result of inherent arterial characteristics. This study delivered collective recommendations, 'do's and don'ts' of microvascular arterial coupling.

Simulation-Based Training Models for Cleft Palate Repair: A Systematic Review.

OBJECTIVE: Simulation-based training is a relatively new inclusion to surgical training curricula, with promises of achieving increased competency while maximizing patient safety. Cleft palate, which contributes significantly to the global burden of surgically treatable diseases, is a challenging repair to learn due to the high level of skill and dexterity required, delicate oral tissues, and limited space of an infant oral cavity. Simulation training can allow cleft palate education to move from an observational to a competency-based learning. Hence, this systematic review presents the models described in the literature that simulate cleft palate repair. DESIGN: The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search of the MEDLINE and Cochrane databases was performed. Qualitative data were extracted, and the models were stratified based on their anatomical fidelity and realism, forming the basis of the curriculum. RESULTS: The database search returned 3261 articles. Twelve articles were considered eligible for inclusion. The anatomical fidelity, human tissue likeness, evidence of improved outcomes, and cost are discussed. CONCLUSIONS: Cleft palate is a globally significant birth defect and its repair is a difficult procedure to learn. This review presents the 12 models of cleft palate described in the literature, highlighting the advances and gaps in current cleft palate simulation.

Craniofacial Anthropometric Profile of East Asians.

Facial anthropometric data has significant ethnic variation. East Asia, comprised of fourteen countries, represents a significant proportion of the global population. This systematic review presents the facial anthropometric data collected from these countries. The systematic review was conducted in accordance with PRISMA guidelines. An electronic search of the MEDLINE database returned 3054 articles. Twenty articles were considered eligible for inclusion. Nine studies were conducted in China, 1 in Indonesia, 2 in Japan,3 in Korea, 4 in Malaysia, and 1 was a multicentre study conducted in China, Japan, Thailand, and Vietnam. Qualitative and quantitative parameters were extracted from the20 studies. No data was found for the other East Asian countries. There is a paucity of facial anthropometric data for East Asian countries despite their high burden of craniofacial anomalies and a strong demand for cosmetic facial surgery, both of which would benefit from the collection of robust craniofacial norms. It is in the interest of both the craniofacial surgeon and the East Asian patient to collect baseline facial anthropometric data for this population.

The South Asian facial anthropometric profile: A systematic review.

PURPOSE: Craniofacial anatomy, as measured by facial anthropometric data, varies significantly between races. South Asia, comprised of eight countries, represents a large proportion of the global population and is the fastest-growing region of the world. This systematic review presents the facial anthropometric data collected for populations from this region. MATERIALS AND METHODS: This systematic review was conducted in accordance with PRISMA guidelines. A systematic review of the literature was conducted by an electronic search of the MEDLINE and Cochran databases, returning 1675 articles. Bibliographies of accepted articles were screened to identify further eligible studies. RESULTS: A total of 12 articles were considered eligible for the systematic review. Two studies were conducted in Bangladesh, 7 in India, and 3 in Nepal. No facial anthropometric data were found for populations from Afghanistan, Bhutan, Maldives, Pakistan, or Sri Lanka. Qualitative and quantitative parameters from the 12 studies were extracted. CONCLUSION: There is a paucity of facial anthropometric data for South Asian populations. As South Asia has a significant prevalence of craniofacial anomalies and a burgeoning cosmetic facial surgery market, it is in the interest of both the craniofacial surgeon and the South Asian patient to collect baseline facial anthropometric data for this population.

Evolution of an evidence-based supermicrosurgery simulation training curriculum: A systematic review.

BACKGROUND: Supermicrosurgery (SM) involves operating on vessels with calibers from 0.3-0.8 mm. SM requires skills beyond those of conventional microsurgery. Current microsurgery courses do not prepare a junior surgeon for such a challenge. Several models have been developed to assist in the early learning curve, but their true purpose, benefit, and validation have not been addressed. This systematic literature review summarizes the existing SM simulation models, and their likely impact on microsurgery training for small-caliber vessel-based procedures is assessed. METHODS: An electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From the literature search, 90 potential articles from MEDLINE and 300 articles from other databases were identified and screened. Twenty-five studies were screened against the inclusion criteria by two independent reviewers for a final critical analysis. RESULTS: Thirty-six articles were included in the reviewing process, and 15 SM simulation training models were identified. The simulation models were classified as nonbiological or biological and as ex vivo or in vivo. None of these models demonstrated validity. However, critical analysis of the full-text articles established the clinical correlation of each model along with the specific skill demonstrated. A novel ladder-based curriculum was established. Further, an expert's questionnaire generated a Likert scale and the clinical impact of each SM simulation training model. CONCLUSION: This is the first review to highlight the clinical relevance of SM models and the need for validation. Currently, a variety of training models in SM appear to enable the acquisition of specific skills, and the clinical impact of a selection is recognized in a proposed SM simulation training curriculum.

The untold story of the scorching sun-A wake up call for sun protection.

Despite extensive warnings from health authorities regarding the dangers of direct sunlight exposure, most people still turn to sun bathing to get a golden tan. Unfortunately, that pleasant tan appearance is often lost because of over exposure to sunlight, resulting in painful red sunburns. In this paper we are reporting a case with significant sunburn injuries that required hospitalization and treatment in a burn center. Concurrently a pilot study was conducted to assess the knowledge about sun protection among the adult population and the results are discussed. The results obtained from the study revealed the lack of knowledge regarding sun protection and sun seeking behaviour among the responders. Deeper burns are rarely caused by direct sunlight exposure and are underreported in literature. Despite extensive health education and warnings, there are significant numbers of sunburn injuries reported annually. On most occasions, these are superficial and are in the form of erythema. Nonetheless, the public is unaware of the impending risks of developing deep sunburn injuries that can occur especially during protracted holiday exposures. Therefore, it is crucial to escalate public awareness and to implement preventive measures to reduce the short and long-term risks of sun exposure.

The Chicken Thigh Adductor Profundus Free Muscle Flap: A Novel Validated Non-Living Microsurgery Simulation Training Model.

BACKGROUND: Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. METHODS: A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. RESULTS: The average time to dissect the flap by novice trainees was 82±24 minutes, by core trainees 90±24 minutes, and by higher trainees 64±21 minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of 3±1.4 (P<0.001). CONCLUSIONS: The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.

Flowmetry evolution in microvascular surgery: A systematic review.

This review aims to provide a summary of the flowmeter devices used in microvascular surgery and assesses their contribution to improving the clinical outcomes of free tissue transfer. Flowmeters are widely accepted as the standard method of intraoperative assessment of the patency of coronary vascular anastomoses, providing thresholds that predict outcome. There is limited evidence regarding the use of flow measurements in plastic surgery microvascular anastomoses; however, flowmetry appears to have some role in postoperative free flap monitoring and prevention of complications. Surgeons rely on subjective clinical robust findings (patency test) as proof of immediate flow. The current literature lacks evidence regarding an objective predictor tool used to evaluate adequate flow changes before and after microvascular anastomosis. An electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement by using the MEDLINE, EMBASE, and Cochrane databases. A combination of algorithms including "flowmeter," "Doppler ultrasound," "transit volume flow," and "laser Doppler flowmeter" meshed with "microsurgery" was used to search for experimental and clinical studies that assess microvascular anastomoses by using a flowmeter device. A total of 718 peer-reviewed publications and 14 full-text articles described the use of microvascular flowmeters to determine anastomotic patency or free flap viability. Flowmeters are currently used to provide the qualitative assessment of microvascular anastomoses. It seems reasonable to expect flowmetry to provide quantitative values that can be used intraoperatively to predict both outcomes and the necessity for an on-table anastomosis revision; this may allow surgeons to better understand the other factors that predict failure by exclusion.