A Single Stage Composite Cleft Septorhinoplasty for Correction of the Mature Unilateral Cleft Nose Deformity - The Gujrat Technique.

OBJECTIVE: To evaluate the results of a single stage composite cleft septorhinoplasty procedure ("The Gujrat Technique") to correct the exaggerated cleft nose deformity after completion of nasal growth in an adult patient cohort. METHODS: Adult patients with a residual unilateral cleft nasal deformity were deemed eligible for the proposed "Gujrat Technique". Over a 10-year period (2007-2017), 96 adult patients underwent this composite cleft septorhinoplasty as a single stage operation. Post-operative nasal symmetry evaluation was undertaken using the validated computer program 'SymNose'. Functional outcome and patient satisfaction were assessed using Nasal Obstruction Symptom Evaluation scale and Rhinoplasty Outcome Evaluation (ROE) questionnaires respectively. Various statistical analysis methods were used to validate the obtained results. RESULTS: Due to poor compliance with follow-up, post-operative assessments were undertaken in only 32 patients. The single group study design using the non-parametric matching pairs Wilcoxon Sign test (p < 0.001) showed overall good to excellent functional and aesthetic outcomes and higher scores of the digital SymNose grading system. There was a significant improvement in ROE scores (from 26.4 ± 2.9 to 85.9 ± 4.7, p < 0.001). There were no major complications or revisions needed in our series. CONCLUSION: The individual components of "The Gujrat Technique" are not novel but their combination in this adult unilateral cleft rhinoplasty cohort has demonstrated a high patient satisfaction with its aesthetic appeal and functional versatility. In the background of limited resources and unpredictable patient follow up, the simplicity, reproducibility and cost effectiveness of this technique make it a practical reconstructive option.

Intensive care unit-acquired weakness in the burn population.

Intensive care unit-acquired weakness is an evolving problem in the burn population. As patients are surviving injuries that previously would have been fatal, the focus of treatment is shifting from survival to long-term outcome. The rehabilitation of burn patients can be challenging; however, a certain subgroup of patients have worse outcomes than others. These patients may suffer from intensive care unit-acquired weakness, and their treatment, physiotherapy and expectations need to be adjusted accordingly. This study investigates the condition of intensive care unit-acquired weakness in our burn centre. We conducted a retrospective analysis of all the admissions to our burn centre between 2008 and 2012 and identified 22 patients who suffered from intensive care unit-acquired weakness. These patients were significantly younger with significantly larger burns than those without intensive care unit-acquired weakness. The known risk factors for intensive care unit-acquired weakness are commonplace in the burn population. The recovery of these patients is significantly affected by their weakness.

Necrotizing fasciitis versus pyoderma gangrenosum: securing the correct diagnosis! A case report and literature review.

OBJECTIVE: To highlight the key differences in history, examination, and management of pyoderma gangrenosum and necrotizing fasciitis and to outline the importance of distinguishing these 2 conditions. METHOD: We present a case report of a gentleman with a background of ulcerative colitis having a 1-week history of an erythematous wound and localized abscess to the right leg that failed to respond to antibiotic treatment and later on to surgical debridement of a presumed necrotizing fasciitis. Following referral to our plastic surgery unit, a diagnosis of pyoderma gangrenosum was made and this was confirmed following a response to steroid therapy within 48 hours. A literature review of pyoderma gangrenosum cases misdiagnosed for necrotizing fasciitis was carried out to compare and contrast pitfalls in misdiagnosing these 2 conditions. RESULTS: Literature review of 10 cases confirmed the association of pyoderma gangrenosum with inflammatory bowel disease, hematological disease, and surgical trauma. The presence of necrotic tissue in a pyoderma gangrenosum lesion can be a diagnostic pitfall; although blood and tissue culture investigations are usually negative in pyoderma gangrenosum, this may not always be the case. Inflammatory markers can be significantly high in pyoderma gangrenosum and pyrexia is not a feature limited to necrotizing fasciitis. CONCLUSIONS: Inappropriate surgical debridement of pyoderma gangrenosum can cause rapid extension of the lesion by enhancing the posttraumatic response and lead to potential reconstructive challenges with psychological repercussions. On the contrary, treating necrotizing fasciitis with immunosuppressive therapy may worsen the condition. The importance of understanding the pathogenesis, clinical features, and management of both conditions cannot be overemphasized.