The use of cyanoacrylate glue for skin grafts stabilisation: A retrospective multicenter study.

Cyanoacrylate (CA) tissue glue is frequently used in various surgical procedures, and it is simple to use and may save time during procedures. We report the use, effectiveness, and postoperative outcomes of patients who have undergone skin graft surgeries in which CA glue was used to stabilise the graft. A retrospective study of patients who underwent skin graft surgeries where CA was used to stabilise the grafts between January 2018 and August 2021 at different medical institutes in Riyadh, Saudi Arabia. The analysis was performed using the Statistical Package for Social Science, version 23.0 (IBM, Armonk, New York). A total of 36 cases were included. Five patients (13.9%) had diabetes. All cases received antibiotics preoperatively. Two types of harvested skin grafts were used: (a) a non-meshed split-thickness skin graft (n = 24, 66.7%), and (b) a meshed split-thickness skin graft (n = 12, 33.3%). The graft uptake outcome was 100% for 32 patients (88.9%). The most common underlying indication of skin grafting was burn 17 (47.2%), in which 5 (13.9%) developed partial graft loss. The percentage of skin grafts taken using CA was high and comparable to other fixation methods. Further studies may be needed to assess the long-term outcomes and cost-effectiveness.

Breast reduction scars: a prospective survey of patient preferences.

BACKGROUND: Studies have shown that scarring is a primary reason for patient dissatisfaction with reduction mammaplasty. OBJECTIVES: The authors prospectively evaluated patient preferences for the 3 most common breast reduction scar patterns: horizontal, vertical, and Wise. METHODS: Sixty-six patients were recruited for the study before receiving their reduction mammaplasty consultation. Each patient was shown line drawings and postoperative photographs of the 3 breast reduction techniques and scored the scars on a modified 10-point Likert scale (1 = unacceptable; 10 = acceptable). The survey responses had no impact on the patients' medical care. A nonparametric Friedman test was used to compare the mean scores, and univariate generalized linear regression analysis was performed to adjust for confounding factors. Post hoc analysis was performed using the Bonferroni method. Significance was set at P < .001. RESULTS: Sixty patients completed the study. The mean preference ranking was significantly higher for the horizontal scar pattern versus vertical and Wise (P < .001). The mean score difference between the horizontal and Wise patterns was 2.982. The mean difference between the horizontal and vertical patterns was 2.27. There was no significant difference in preference between the vertical and Wise patterns. Linear regression analysis showed that age, body mass index, and torso/bra size had no significant effect on preference. CONCLUSIONS: To our knowledge, this is the first study designed to prospectively evaluate patient preferences regarding postoperative scars. Results indicate that the horizontal technique is preferable with respect to scar placement.

"Basal cell carcinoma of the hand: A systematic review and meta-analysis of incidence of recurrence".

Background: Hand basal cell carcinoma is a rare and complex disorder. Due to the hand's anatomical features, managing hand BCC is challenging. Therefore, we have conducted this systematic review to investigate various clinical characteristics, investigations, and treatment options related to hand BCC. Furthermore, a meta-analysis was used to provide pooled recurrence rates. Methods: We conducted this review per the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. This study performed a systematic literature review in February 2022 using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Key terms include hand basal cell carcinoma, basal cell carcinoma, management, outcome, and recurrence. We evaluated articles according to predefined quality criteria. Results: The study included 9725 patients and 51 published articles. A total of 35 case reports, 2 case series, 1 prospective study, and the remaining retrospective studies were evaluated. An asymptomatic skin lesion was the main complaint. In 10 studies, Moh surgery was the most frequently used treatment method. In the seven studies included in the meta-analysis, the overall incidence rate of recurrence among the included patients was 1.49 cases per year. Conclusion: The optimal extent of surgical treatment is still controversial, though an early biopsy can help identify lesions at an early stage. It is the first study to provide occurrence rates based on a meta-analysis. Developing treatment guidelines for BCC of the hand will be the focus of future research.

A Novel Otoplasty Technique Using Dermabrader on Prominent Ear Deformity Patients: A Retrospective Study and a Description of Technique.

Approximately 5% of the population has protruding ears. An antihelix deficiency or absence is a common cause of ear protrusion. Although there are over 200 techniques to manage prominent ears, there is no evidence to support using dermabraders in this situation. To the author's knowledge, this is one of the first articles to assess the clinical outcome of dermabrader use on patients with prominent ear deformities. Methods: An analysis of retrospective medical records was conducted by the senior author on patients with prominent ears treated with our novel dermabrasion technique between 2018 and 2021. The demographics, clinical assessment, and outcomes of the patients were assessed. Furthermore, the article provides a detailed description of the technique. Results: A total of 18 ears were operated on. Eight of the included patients had bilateral ear deformities, and two had unilateral deformities. The mean distance from the ear to the head at the superior helix was 29 mm (range, 25-35 mm). In our series, no complications were observed. During the most recent clinical evaluation, all patients had achieved acceptable ear positioning and excellent aesthetic results. Conclusions: Dermabrasion is a useful technique for otoplasty because no sutures are required and symmetry can be achieved in bilateral ears. Furthermore, this technology is safe, simple, reproducible, reliable, and versatile. We recommend that future studies be conducted in a prospective manner with larger sample sizes and longer follow-up periods to ensure the validity of the findings.

"Anesthesia for Endoscopic Carpal Tunnel Syndrome Release: A Comprehensive Systematic Review and Meta-Analysis of Local Versus Regional Versus General Anesthesia".

Background: Worldwide, carpal tunnel syndrome (CTS) is the most common peripheral neuropathy due to compression. A minimally invasive endoscopic carpal tunnel release (ECTR) procedure is available to treat this condition. This study aims to identify and compare the different types of anesthesia in ECTR, particularly in terms of functional outcomes, patient satisfaction, and operative time. Methods: PRISMA guideline was used to design and conduct this systematic review. MEDLINE, Cochrane, and EMBASE databases were searched systematically from inception to May 2022. For the search, MeSH terms such as ECTR, general anesthesia, local anesthesia (LA), and regional anesthesia were used. Results: As a result of reviewing the literature, 198 publications were reviewed. After implanting our criteria, 12 studies were included. We included 14589 patients who underwent ECTR. LA has a higher satisfaction rate and a shorter operative time than general anesthesia. LA had a mean operative time of 20.1 min, compared to 45 min and 51 min for regional anesthesia and general anesthesia. The number of patients with postoperative ECTR surgical complications was 2.7% (95%CI). After ECTR with LA, 95% of patients are back to their daily routine within six months. Conclusion: All the reported methods were effective, with LA being the most commonly used. Furthermore, it showed a shorter operative time and a higher satisfaction rate than other types of anesthesia. Due to the heterogeneity of the data, we recommend future randomized controlled trials to highlight the differences in anesthesia types used in ETCR. Level of evidence: III, risk/prognostic study.

The potential pitfalls of synovial sarcoma mimicking intraneural ganglion cyst: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Synovial sarcoma is a rare soft tissue sarcoma (STS) that accounts for 5-10 % of all STS. Synovial sarcoma of the peripheral nerve is very rare, with only 26 cases reported in the literature. Hence, this case report describes an unusual presentation of synovial sarcoma mimicking intraneural ganglion cysts and a literature review. PRESENTATION OF CASE: We describe a 36-year-old female who presented to our clinic complaining of left leg pain for six years. MRI was done, which revealed a cystic lesion. With an impression of intraneural ganglion cyst versus nerve sheath tumor of the common peroneal nerve. The patient underwent exploration surgery and mass excision. The mass was sent for histopathology following excision, where the results indicated monophasic synovial sarcoma. An additional surgery, an epineurectomy of the common peroneal nerve and tumor bed excision, was followed by adjuvant chemotherapy with a Doxorubicin-based regimen. Following surgery, our patient's neurological symptoms improved. CLINICAL DISCUSSION: The mainstay of treatment in synovial sarcoma is surgical excision with a Doxorubicin-based regimen of chemotherapy and/or radiotherapy based on tumor characteristics. Tumors smaller than 5 cm in MRI usually show homogenous enhancement and can be mistaken for benign tumors. Hence, a biopsy should be done before surgery to avoid misdiagnosis. CONCLUSION: Even though it is extremely rare, synovial sarcoma of the lower extremity should be considered when a painful swelling of the lower leg is associated with a long duration of symptoms. Such lesions are best managed by surgical excision and postoperative chemotherapy.

Advancing Surgical Education: A Comprehensive Systematic Review with Meta-Analysis and Novel Approach to Training Models for Local Skin Advancement Flaps.

Performing local skin flaps is a challenging task that requires cognitive and technical skills to design flaps with proper orientation to avoid distorting normal anatomy. Junior trainees need adequate exposure to gain confidence and expertise in such procedures. This article systematically reviews the literature's different local skin advancement flap training models and describes a new, easy-to-use training model. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Web of Science, and Google Scholar databases were searched from their inception until August 2022 for articles about local skin advancement flap training models. The meta-analysis results were pooled across the studies using a random-effects model and presented as a weighted mean difference with a 95% confidence interval (95% CI). Out of 773 reviewed articles, 18 were included in the systematic review, and four reported enough data to be included in the meta-analysis. Rhomboid and Z-plasty flaps were the most commonly taught flaps by training models. The most commonly used training models were synthetic-based, followed by animal-based models. The training models significantly increased the trainees' confidence and expertise regarding local skin flap procedures (p<0.00001) for both domains. Training models, per our reported data, significantly improve the trainees' confidence and expertise in performing local skin advancement flap procedures; continuous efforts in developing and establishing new, simple-to-use, and effective training models are strongly encouraged to further improvement of surgical education and enhance the trainees' surgical skills.

Patient Compliance With Physical Therapy Following Orthopedic Surgery and Its Outcomes.

BACKGROUND AND OBJECTIVES: Patient compliance is a major concern for the efficacy of physiotherapy amongst those that undergo orthopedic surgery. The substantial number of people who are non-compliant makes this an imperative issue to address. Our objectives were to quantify the percentage of patient compliance for physiotherapy after their surgery, to measure the association between compliance and the status of health, mobility, and pain, and to identify the causes of non-compliance. METHODS: A cross-sectional study was conducted on post-orthopedic surgery patients attending physical therapy sessions at King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia, over a one-year period. The sample size of 359 was calculated and selected using simple random sampling. Our questionnaire was developed by adopting questions from two previously validated studies. RESULTS: The majority of the participants (n=194; 54%) were male. One hundred and ninety-three (53.8%) participants had a diploma or higher. The age group 18-35 was found to be significantly associated with skipping physiotherapy sessions when they started to feel well (P= 0.016) and skipping due to other responsibilities (P=0.002). Single people skip physiotherapy when they start to feel well (P=0.023), due to other responsibilities (P=0.028), and due to poor timing (P=0.049). Self-reported compliance to physical therapy after surgery was 231 (64.3%). Patient status showed overall improvement. CONCLUSION: There is a significant percentage of non-compliance and the patient's age, gender, marital status, and level of education play a role in the causes of non-compliance. In addition, the patient's status (health, pain, and mobility) is better in those who are compliant than in those who are not.

Antiseptic Techniques in Breast Implant Surgery: Insights From Plastic Surgeons in Saudi Arabia.

Background: Breast implant surgery is a popular procedure worldwide, and the same holds true for Saudi Arabia. Ensuring a sterile surgical environment is crucial to avert postoperative infections. This study explores the various antiseptic techniques adopted by Saudi plastic surgeons during breast implant procedures. Objectives: This study aims to assess Saudi plastic surgeons' adherence to antiseptic measures in breast implant surgery, and determine what types of antiseptic measures are most commonly used among Saudi plastic surgeons. Methods: The authors conducted a cross-sectional survey among board-certified plastic surgeons in Saudi Arabia, collecting data through a self-administered online questionnaire. This questionnaire, which covered their demographic information and their antiseptic practices during breast implant surgery, was disseminated via a WhatsApp (Menlo Park, CA) broadcast message from May 15 to June 27, 2023. Results: Of the 52 Saudi plastic surgeons who completed the questionnaire, all reported employing preoperative antibiotics and skin disinfection. Other measures included pocket irrigation (86.5%), implant irrigation (92.3%), sleeve/funnel usage (65.4%), nipple shield usage (51.9%), and glove change during the procedure (96.2%). Nearly, all respondents used only a surgical cap for head cover (96.2%) and postoperative antibiotics as prophylaxis (98.1%). However, more than half of them did not minimize door movement during the procedure (51.9%). Conclusions: This study offers a valuable insight into the antiseptic practices during breast implant surgery in Saudi Arabia. The findings underline the need for further research to establish evidence-based guidelines for antiseptic practices in this field.

Unusual Location of Pulp Glomus Tumor: A Case Study and Literature Review.

Glomus tumors are painful, benign tumors that develop from the glomus bodies. They account for less than 1% of tumors in hand, and less than 10% present in the pulp of the digits. Cold hypersensitivity, increased pinprick sensitivity, and paroxysmal pain are common glomus tumor symptoms. We describe a 27-year-old man who came with pain in the right little digit, confined to the pulp for 10 years. The tip of the finger was extremely sensitive to touch, and the pain worsened in a cold atmosphere. Upon palpation, no mass was recognized. There was pinpoint tenderness within the distal volar pulp of the little finger. MRI with a contrast of the right little digit showed a 2-mm enhancing lesion in the tip of the little finger. An incision was done over the volar plane of the little finger, removing the tumor bluntly. The tumor was found to be a glomus tumor after histologic evaluation. Glomus tumors of the volar pulp are notoriously hard to detect. Hence, the presence of localized pain in the volar tip for the finger should raise suspicion of the diagnosis of a glomus tumor, and surgical removal should be offered to relieve symptoms and avoid recurrence.

Impact of the Coronavirus Disease 2019 Pandemic on the Patterns and Characteristics of Plastic Surgery Practice: A Retrospective Comparative Study of Before and During the Pandemic.

Background Plastic surgery practices have changed drastically during the coronavirus disease 2019 (COVID-19) pandemic, as most non-elective surgeries were deferred owing to the high presumed risk of infection transmission. Therefore, this study aimed to assess the impact of the COVID-19 pandemic on the patterns and characteristics of plastic surgery in an academic medical city. Methods This retrospective comparative study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. We reviewed data from patient medical records during the pandemic period (from March 2, 2020, to December 31, 2020) and the corresponding pre-pandemic period, defined as the same timeframe in the preceding year (from March 2, 2019, to December 31, 2019). Results The total number of admitted patients in the pre-pandemic period was 479 and in the during-pandemic period was 254, indicating a 46.97% reduction in admission frequency. The median length of hospital stay was significantly shorter in 2020 than in 2019 (1.62 ± 1.74 days versus 2.13 ± 4.18, respectively, p = 0.011). The during-pandemic period was characterized by significantly higher frequencies of urgent procedures (9.8% versus 5.4% in 2020 and 2019, respectively, p = 0.025) and lower frequencies of elective procedures (90.2% vs. 94.4% in 2020 and 2019, respectively, p = 0.035) than the pre-pandemic period. Conclusion The number of plastic surgeries performed has decreased since the onset of the pandemic. However, the impact of the pandemic on plastic surgery practices remains unclear. Further studies are needed to determine the effects of this pandemic on patient outcomes.

Plastic Surgery in the Gulf Cooperation Council Countries: Role of Telemedicine.

Internationally, telemedicine is finding its way into common day plastic surgery practice as a result of the COVID-19 pandemic. Nonetheless, no data about its practice in the Gulf region are available to date. Methodology: This is a cross-sectional survey-based study that was sent online to the plastic surgeons practicing in the Gulf region. The study aimed to look into the integration of telemedicine into the practice and the surgeons' attitude and future vision about it. Participation was voluntary, and confidentiality was preserved. Results: A total of 229 plastic surgeons enrolled in this study in mid-2020. There were 192 male participants (83.8%) and 37 female participants (16.2%). Of these, 99 (43.2%) practiced in Saudi Arabia, 85 (37.1%) in the United Arab Emirates, 24 (10.5%) in Oman, 18 (7.9%) in Kuwait, and three (1.3%) in Bahrain. In total, 85 (37.1%) used telemedicine during lockdown, and 144 (62.9%) thought that its usage will remain beneficial in the future. There was no significant difference in practicing telemedicine in different plastic surgery subspecialties, varying level of experience, and country of practice. Among those who used virtual consultations, 62 (72.9%) did not charge for consultation fees. Conclusion: The tendency toward telemedicine integration in plastic surgery practice is growing worldwide, especially after COVID-19. Its limitations are outweighed by its advantages and, with time, many of these will be bypassed. New innovations driven by advancement in technology will further embed telemedicine into the practice.

Hand Surgery in Saudi Arabia.

Hand surgery is a unique field that incorporates multiple specialties, aiming to provide the patient with a best possible functional and aesthetic results. Hand surgeons deal with different pathologies that require skills in several aspects of surgery. The field of hand surgery has evolved significantly over the past decades across the globe. This specialty has also been evolving in Saudi Arabia over the past 25 years. Some of the services offered to patients include specialized centers for brachial plexus, peripheral nerve, and pediatric hand surgery as well as centers for work-related hand injuries. There has also been significant contribution to the hand surgery literature from the hand surgeons working in Saudi Arabia, with hundreds of papers published in journals pertaining to hand surgery, orthopedic surgery, and plastic surgery, as well as the publication of several novel mutations causing congenital hand defects in journals concerned with genetics. The recent approval of a hand and microsurgery fellowship program in Saudi Arabia will also help boost this field in the country and the region.

Perceptions of Saudi Plastic Surgery Residents and Attendings of Online Education during the COVID-19 Pandemic.

BACKGROUND: The world has faced an unprecedented challenge in controlling the spread of COVID-19-a rapid reshaping of the healthcare system and education was inevitable. Consequently, residency programs adopted e-learning as a social distancing tool for the continuity of the learning process. In this study, we explore the opinions and perspectives of plastic surgery attending doctors and residents on the implications of e-learning. METHODS: After obtaining ethical approval, this cross-sectional study was conducted electronically between October and December 2020 among plastic surgery residents and board-certified plastic surgeons in Saudi Arabia. Participants completed a validated, anonymous, self-administered questionnaire. The questionnaire gathered participants' demographic data, perceptions of online webinars, and audiovisual evaluations. Finally, we compared traditional (in-person) teaching with online webinars. The analysis was performed at a 95% confidence interval using the Statistical Package for Social Sciences (SPSS), version 23.0 (IBM, Armonk, N.Y.). RESULTS: A total of 61 responses were included in this study. The majority of respondents (78.7%) were comfortable during webinars, with 38 (62.3%) believing they should supplement traditional teaching methods. Overall, 50.8% were satisfied with the webinars. However, 37.7% were neutral. Most believed that the webinars increased their clinical (67.2%) and surgical skills (67.2%) to reasonable levels. CONCLUSIONS: Online education provided an excellent educational tool as a viable option to supplement traditional face-to-face training, with most residents being satisfied, supporting the use of this educational tool. More objective research is required to refine existing online plastic surgery teaching methods while creating novel distance e-learning approaches for the future.

Public Awareness of Breast Implant-associated Anaplastic Large Cell Lymphoma in Saudi Arabia.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was first reported in 1997. Since then, the number of reported cases has been increasing, and patients' knowledge and perceptions about this condition are unclear. This study aimed to evaluate the public knowledge and perceptions toward BIA-ALCL and its association with cosmetic/reconstructive breast implants in Saudi Arabia. METHODS: In this cross-sectional, online survey-based study, women aged 18-60 years in Saudi Arabia were the target population on social media platforms. Questions included data on demographics, experience of implants, and knowledge and concerns regarding BIA-ALCL. RESULTS: A total of 543 women participated in this study, with a mean age of 34 years. Only 1.9% had breast implants due to cosmetic or reconstructive reasons, whereas 9.8% expressed their desire of having implants in the future. More than half (57.3%) of the respondents had never heard of BIA-ALCL in comparison with 21.7% who had an established background. After reading the highlights on BIA-ALCL, 60% of the women with breast implants still wanted to keep their implants and 42.5% of the ones who desired breast implants would still aim to have them. Almost all the sample stated that BIA-ALCL should be included in the written consent. CONCLUSIONS: Nearly half of Saudi women have not heard of BIA-ALCL, and report that it is an important part of the surgical consultation and informed consent. Our role as plastic surgeons is to raise the awareness of BIA-ALCL through social media and health care settings to maximize the safety of women with breast implants.

Role of the Pedicled Mentalis Muscle Flap in Closure of Chin Implants in Genioplasty.

With the purpose of obtaining an aesthetically pleasing chin appearance, genioplasty or chin augmentation can be performed through osteotomy or chin implantation, with the latter available in different sizes and materials such as silicone and porous polyethylene. The implants are traditionally placed in a subperiosteal or supraperiosteal plane with different advantages and disadvantages to each. This procedure has evolved through time with many techniques and modifications; and this article is an addition to this ongoing refinement by advocating for closure of the mentalis muscle (a paired chin muscle originating from the incisor fossa to the chin skin) over the implant after securing its position with screws (in the case of porous polyethylene) or creating a snug pocket (in the case of silicone). In this retrospective analysis, 15 patients underwent this procedure with an excellent outcome. A single patient developed numbness in the mandibular nerve territory, while another one developed a fistulating radicular cyst that was unrelated to this technique. In addition to the simple learning curve, the potential advantages of this technique include less chances of fistula formation, implant exposure, infection, extrusion, or malpositioning. Prospective studies with more subjects are required to cement our findings.

Assessment of the Academic Productivity of Plastic Surgeons in Saudi Arabia Using the h-index.

Hirsch-index (or h-index) is a bibliometric measure calculated for researchers based on number of publications and their citations. This study examined the h-index of board-certified plastic surgeons in Saudi Arabia and the different factors that may influence it. METHOD: In this cross-sectional study, an electronic questionnaire was sent to 156 board-certified plastic surgeons practicing in Saudi Arabia. Using their names, we conducted an online search on Scopus, Semantic scholar, and Google scholar to calculate their h-index. Bivariate and multiple regression analyses were conducted to determine the relationship of those factors with the index. RESULTS: A total of 84 surgeons participated in this study, of whom 83.3% were men. Our sample scored a mean index of 1.7 and published a mean of 5 articles. More publications and a higher academic rank predicted a higher h-index, (ß = 0.79, P < 0.001) and (ß = 0.14, P 0.017), respectively. On the other end of the spectrum, the country of residency training (P 0.33), the year of training completion (P 0.95), attaining fellowship training (P 0.95), the number of fellowships (P 0.20), interest in research (P 0.74), working in an academic hospital (P 0.44), or attaining a higher degree (P 0.61) were not significant independent predictors of the index. CONCLUSIONS: More publications and a higher rank predicted increased academic productivity among the plastic surgeons in Saudi Arabia. Despite its limitations, h-index is a useful measure that can be considered in promotions and applications to prestigious plastic surgery centers in adjunct to other factors.

Bilateral scaphoid fractures: Case report and literature review.

BACKGROUND: Traumatic bilateral scaphoid fractures are extremely rare. Here, we report an unusual mechanism of bilateral scaphoid fracture after road traffic accident. CASE REPORT: A 32-year-old male presented with bilateral wrist pain to our plastic surgery clinic six months after he was involved in a road traffic accident. He was diagnosed with bilateral scaphoid fracture based on his CT scan findings. It is noteworthy that at the time of collision, he had grasped the steering wheel strongly to brace himself and had suffered no significant injuries except for bilateral wrist pain. DISCUSSION: The diagnosis may be missed in our case because of bilateral hand pain complaints and normal X-ray report. Thus, we suggest that CT scan should be performed in similar incidents, particularly in case of normal X-ray reports. CONCLUSION: It is recommended that CT scan should be performed in similar mechanism of injury with a high index of suspicion.

The Epidemiology of Burn Injuries in Saudi Arabia: A Systematic Review.

Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, "Saudi Arabia," coupled with the search terms "burn," "thermal burn," "flame burn," "chemical burn," "electrical burn," and "contact burn" to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10-12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to <40% total body surface area, while roughly 60% were second-degree burns. Most patients remain in the hospital for 1 to 4 weeks. The overall mortality across studies including patients of all ages was 6.9%, while just 0.76% in the two studies restricted to pediatric patients. Scald injuries involving young children comprise the lion's share of burn injuries in Saudi Arabia. Increased public awareness is necessary to reduce the incidence and severity of these potentially catastrophic injuries.

Extended Transverse-oblique Back Flap for Myelomeningocele Defect Closure: A Case Series of 10 Patients.

BACKGROUND: Myelomeningocele is the most common phenotype of congenital neural tube defects. Various reconstructive techniques have been described for soft tissue coverage following myelomeningocele repair, one of which is the use of dorsal intercostal artery perforator based flaps. The aim of this study was to describe our experience with the use of a transverse-oblique back flap that can be reliably extended to the anterior axillary line for closure of myelomeningocele defect. This pedicle transposition flap is based on thoracic or lumbar paraspinal perforators that originate from the dorsal intercostal arteries. METHODS: This is a retrospective two center case-series where all patients who underwent myelomeningocele defect closure with extended transverse-oblique flap over three years period were included. Patients' clinical data, surgical variables, and outcomes were documented and analyzed using descriptive measures. Flap harvest technique is also delineated in the present study. RESULT: Ten newborns (7 baby girls and 3 baby boys) who underwent a surgical closure of the myelomeningocele defect with an extended transverse-oblique back flap during the first week of life were included in the analysis. The defect was most commonly located in the lumbosacral area (50%) followed by the lumbar area (40%), with an overall average surface area of 22 ± 8.32 cm2. Common encountered complications include venous congestion to the distal part of the flap and minor wound dehiscence of less than 0.5 cm, all were managed conservatively. There were no incidences of flap loss or full necrosis. Primary closure of the donor site was possible in all cases. CONCLUSIONS: In the current series, the extended transverse-oblique back flap provided a safe and reliable coverage for myelomeningocele defect. Such a flap does not jeopardize other regional fasciocutanous or musclocutaneous flaps that might be needed for soft tissue coverage later in life for this population. It also obviates the placement of skin suture line over the repaired neural tube, thus yielding a durable coverage with no major complications or functional disability.