Autologous fat transfer for thumb carpometacarpal joint osteoarthritis: a prospective study

The publication “Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Study”1 presents a new surgical treatment for base of thumb osteoarthritis (OA). The associated commentary hails it as a potential breakthrough. We believe there are methodological flaws that warrant attention. First, it was presented as a ‘pilot study’ building on a previous case series of five patients. However, there was no a priori sample size calculation, statistical analysis plan or published protocol. The authors even acknowledge it was not powered for statistical analysis but go on to statistically analyze the data and draw conclusions from the results. It would be better described as an IDEAL Collaboration stage 2A development study.</p

Perioperative thromboprophylaxis in digital replantation: a systematic review

Background There is no international consensus on the use of perioperative thromboprophylaxis in digital replantation. Suboptimal perioperative management may lead to replant failure which compromises extremity function, worsens psychosocial outcomes for patients and incurs significant cost. This systematic review evaluates and compares the efficacy and safety of perioperative antithrombotic protocols used in digital replantation. Methods A PRISMA-compliant prospectively registered (PROSPERO CRD42018108695) systematic review was conducted. Cochrane Central Register of Controlled Trials, Medline, EMBASE and Scopus were searched up until December 2019. Articles were assessed for eligibility in duplicate by two independent reviewers. All comparative studies which examined the use of perioperative thromboprophylaxis in digital replantation were eligible for inclusion. Results Collectively, 1,025 studies were identified of which 7 met full inclusion criteria reporting data from 635 patients (908 digital replants, 86% male, average age 37.3 years). Laceration was the most commonly reported mechanism of injury (68%) with 33% of replantation occurring in Tamai zone III. Fourteen distinct perioperative protocols were identified. One study reported significantly higher digital survival with continuous heparin infusion versus bolus heparin. Five studies demonstrated a significantly higher incidence of complications amongst patients treated with systemic heparin. Conclusions The clinical efficacy and safety of peri-operative antithrombotic therapy following digital replantation remains equivocal. The perceived benefits of improved digital survival must be tempered against the adverse systemic side effects of antithrombotic and anticoagulant therapies until further prospectively collected data sets become available

A morphometric analysis of the suitability of the transverse cervical artery as a recipient artery in head and neck free flap microvascular reconstruction

Purpose Gold standard recipient arteries in head and neck free flap microvascular reconstruction are currently branches of the external carotid. However, these arteries can be compromised by neck dissection or radiotherapy, resulting in ‘vessel-depleted neck’ and ‘frozen neck’ respectively. In such cases, the transverse cervical artery (TCA) may be a suitable recipient artery. Methods The origin, course and diameter of the TCA were determined in 46 sides of neck from 23 cadavers. The distances from the origin of the TCA to the angle of the mandible, floor of the mouth and mandibular symphysis were measured to determine the pedicle length required for free flap anastomosis. Results The TCA was present bilaterally in all subjects investigated and its course across the posterior triangle of the neck was constant between individuals. The mean distances from the origin of the TCA to the angle of mandible, floor of mouth and mandibular symphysis were 10.0, 9.2 and 12.6 cm, respectively. There were no significant differences in these distances between the left and right sides of the neck (p > 0.05 for all comparisons). The distances from the TCA origin to the angle of the mandible and floor of the mouth were significantly longer in males than in females (p = 0.004) and correlated directly with the greater height of males compared to females (p = 0.0004). The mean diameter of the TCA measured 2 cm from its origin was 2.2 mm. Conclusion The TCA is a suitable and reliable recipient artery for free flap microvascular reconstruction, when branches of the external carotid artery are unavailable

Intralesional excision with topical intralesional cryotherapy improves the treatment of keloid scarring in a paediatric patient

Recurrent keloid scarring has a significant impact on quality of life. Management is complex, particularly for scars resistant to conventional treatments and in paediatric cases where radiotherapy is not a suitable adjunct to surgical excision. We present the case of a nine-year-old African Caribbean girl with multiple large and recurrent keloid scars on both ears and bilateral sensorineural deafness. Following repeated intralesional excisions, corticosteroid and botulinum toxin injections, she continued to experience rapid recurrence of her keloids, worsening pain and pruritus. She was no longer able to wear her hearing aids because of the large size of the keloids. We employed a novel technique using topical intralesional cryotherapy, applying liquid nitrogen intraoperatively to the inside of the skin flaps immediately post-intralesional keloid excision and before wound closure. At 26-month follow-up a good aesthetic and symptomatic result was achieved, with minimal hypopigmentation, significantly reduced scar volume and significantly slowed recurrence. We discuss this case and review the current literature on the use of topical intralesional cryotherapy for keloid scarring. </jats:p