Preoperative versus Post-operative Radiotherapy for Extremity Soft tissue Sarcoma: a Systematic Review and Meta-analysis of Long-term Survival.

BACKGROUND: The role of perioperative radiotherapy in the management of resectable extremity soft tissue sarcoma (ESTS) is widely recognised for local tumour control, wound complications (WC) and long-term function. However, debate continues regarding its implications on long-term survival. This study aimed to determine whether the timing of perioperative radiotherapy affects long-term survival outcomes in adults with ESTS. METHODS: A systematic literature search of MEDLINE, EMBASE, Web of Science and Cochrane was performed. The primary outcome measure was the pooled hazard ratio (HR) at 95% confidence intervals. Secondary outcomes and subgroup analyses were presented as cumulative odds ratios (OR). A random-effects, generic inverse variance method and sensitivity analysis were performed to minimise heterogeneity. RESULTS: Six studies (n = 4192 patients) were identified. Time-to-event analysis demonstrated a statistically significant advantage in post-operative radiotherapy for overall survival (HR 1.15 and p = 0.05). Combined HRs for disease-free (1.25 and p = 0.22) and disease-specific (1.06 and p = 0.43) survival also favoured post-operative radiotherapy but did not achieve statistical significance. Post-operative radiotherapy was shown to confer an overall (OR 1.19 and p = 0.01), disease-free (OR 1.19 and p = 0.01) and disease-specific (OR 1.19 and p = 0.01) survival advantage on subgroup analysis. This survival benefit was best observed at three years in the disease-free survival comparison (OR 1.55 and p = 0.003). Preoperative radiotherapy was associated with more WC (OR 2.74 and p<0.00001). CONCLUSIONS: Pooled analysis of published literature suggests that post-operative radiotherapy confers a significant long-term survival advantage with fewer WC. Further large multicentre randomised controlled trials with long-term follow-up are required to determine the optimal perioperative radiotherapy regime in adult ESTS.

The efficacy of the Cook-Swartz implantable Doppler in the detection of free-flap compromise: a systematic review protocol.

INTRODUCTION: The Cook-Swartz implantable Doppler monitors venous or arterial blood flow from free flaps and can detect free-flap compromise. Previous studies have shown that the use of this Doppler can improve detection and salvage rates as it provides an earlier warning than the current method of clinical assessment. Such studies assert that the implantable Doppler is of great value in monitoring free flaps in current microsurgical units. This systematic review aims to compare the efficacy of the Cook-Swartz implantable Doppler in monitoring free-flap compromise against conventional clinical free-flap monitoring techniques. METHODS AND ANALYSIS: Various electronic databases will be systematically searched for studies that compare the use of Cook-Swartz implantable Doppler with clinical assessment. The selected studies will then have their titles and abstracts screened by two authors. Articles selected after title and abstract screen will have full text downloaded and the complete article will be assessed for suitability. Once the articles have been selected for inclusion, data extraction will take place. For data analysis, the outcomes of the studies will be tabulated, with descriptive statistics performed as appropriate and the detection rate of the Doppler and clinical assessment will be compared and synthesised where possible. ETHICS AND DISSEMINATION: The authors hope to disseminate the findings as widely as possible. This systematic review will be published in a peer-reviewed journal and include a number of recommendations as its conclusion based on the evidence contained within. Given the wide range of specialties now utilising flaps, it will be presented at a wide range of national and international conferences. PROTOCOL REGISTRATION IN PROSPERO: CRD42013005818 The literature search and data extraction went on until 28 January 2014. These steps were revised in line with peer review comments.

Cutaneous lasers and skin camouflage make-up: a useful alternative intervention for periorbital hairy congenital melanocytic naevus.

Periorbital congenital melanocytic naevi can be very disfiguring and difficult to treat effectively. Although surgical excision and reconstruction is the most widely accepted treatment strategy, we describe a case in which cutaneous lasers treatment followed by the application of cosmetic skin camouflage make-up provided an alternative solution delivering a good cosmetic improvement.

Hypospadias surgery in plastic surgery: a snapshot of today with an eye on tomorrow.

The current provision of hypospadias correctional surgery lies across the specialities of paediatric surgery, general surgery, urology and plastic surgery. This study aimed to look at how this provision is structured within plastic surgery, what plastic surgeons are currently doing and how this impacts on training. All plastic surgery units within the UK were contacted via letter and telephone in order to ascertain their current practice with regard to hypospadias surgery. Specialist registrars in the West Midlands Deanery were also questioned on their training in this area. The results indicate that 42 plastic surgeons in the UK carry out hypospadias surgery. The majority of clinicians use the Bracka two-stage repair (88%), with Snodgrass (45%) and MAGPI (43%) widely used. Operations are being carried out across the age spectrum from birth, with 51% favouring intervention at 3 years or more. Approximately two-thirds of plastic surgeons treat less than 25 patients per year. One-third treat 26 to 50, with only two clinicians claiming to treat more than 50 patients per year. Of the specialist registrars questioned in the West Midlands Deanery the majority (74%) were confident with the assessment of new cases and in obtaining consent. One-quarter of registrars (28%) only wished to carry out hypospadias surgery once they were consultants, with only one feeling that they had the necessary training to achieve this now. Plastic surgeons represent about half (52%) of the consultants currently identified in the UK as carrying out hypospadias surgery. If this provision is to be maintained then a greater opportunity for development of skills and experience needs to be created within plastic surgery training. The authors advocate the formulation of a coordinated national framework for the provision of this service, promoting a regional focus for skills and governance.

Familial Dandy-Walker syndrome: a case report supporting an autosomal inheritance.

INTRODUCTION: We report an isolated pedigree in which a consanguineous couple had twin sons with Dandy-Walker malformation (DWM). The mother is similarly affected with the disorder. DISCUSSION: DWM is an abnormality of the central nervous system, which leads to hydrocephalus and is associated with other abnormalities. CONCLUSION: Inheritance of the disorder remains controversial, with the majority perceived to be sporadic cases. This report suggests an autosomal inheritance.