Epidemiology of peripheral nerve and brachial plexus injuries in a trauma population.

BACKGROUND: Understanding patterns of peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs) is essential to preventing and appropriately managing nerve injuries. We sought to assess the incidence, cause, and severity of PNIs and BPIs sustained by patients with trauma. METHODS: We conducted a retrospective review of the Trauma Registry Database (January 2002 to December 2020) to identify patients with PNIs or BPIs. RESULTS: We evaluated data from 24 905 patients with trauma; 335 (1.3%) sustained PNIs (81% male; mean age 36 yr, standard deviation [SD] 16 yr) and 64 (0.3%) sustained BPIs (84% male; mean age 35, SD 15 yr). Nerves in the upper extremities were more commonly affected than those in the lower extremities. Sharp injuries (39.4%) and motorcycle accidents (32.8%) were the most frequent causes of PNIs and BPIs, respectively. Other common causes of PNI were motor vehicle collisions (16.7%) and gunshot wounds (12.8%). Many patients with PNIs (69.0%) and BPIs (53%) underwent operative management. The most frequent reconstruction for PNI was primary nerve repair (66%), while nerve transfers (48%) were more frequently used for BPI. CONCLUSION: Nerve injuries in the trauma population have decreased over the last 3 decades with shifts in mechanisms of injury and use of imaging, electrodiagnostic tests, and surgery. Nerve injuries are often complex and time-sensitive to treat; understanding changes in trends is important to ensure optimal patient management.

COVID-19 Restrictions Presented Opportunities and Challenges for Plastic Surgery Residents.

BACKGROUND: Restrictions placed during the COVID-19 pandemic to prevent viral spread led to substantial changes in surgical resident education. The aim of this study was to assess the positive and negative impact of COVID-19 on plastic surgery education and training and provide recommendations for continued competency. METHODS: A cross-sectional online survey of plastic surgery residents across Canada was used to evaluate the impact of COVID-19 on clinical exposure, experience with virtual education, and long-term impact of COVID-19 on surgical training. RESULTS: This study included 61 plastic surgery residents (40% participation rate). Common educational modalities used during COVID-19 included online seminars (95%) and workshops (58%). Teaching sessions were effective if structured around patient cases (72%), recorded (66%), and limited to 1 hour (64%). There were mixed reactions towards online education sessions; residents reported feeling grateful (54%), motivated (38%), enthusiastic (28%), overwhelmed (41%), pressured to participate (23%), and anxious (13%). There were significantly less residents who felt that their clinical exposure was sufficient during (21%) versus before (72%) pandemic restrictions (P < .001). Overall, 87% of residents felt that the pandemic had a negative impact on their training, surgical skill development, fellowship plans, and job prospects. CONCLUSIONS: During the initial wave of COVID-19, residents faced altered educational opportunities, which elicited positive and negative emotions with concern regarding surgical skill development and impact on future career plans. Characterizing early educational impact on residency training to identify opportunities for change is worthwhile as the overall effect of the pandemic is ongoing and remains uncertain.

HISTORIQUE: Les restrictions imposées pendant la pandémie de COVID-19 pour en éviter la propagation virale ont entraîné des changements importants dans la formation des résidents en chirurgie. La présente étude visait à évaluer les répercussions positives et négatives de la COVID-19 sur l'enseignement et la formation en chirurgie plastique et à formuler des recommandations sur le maintien des compétences. MÉTHODOLOGIE: Les chercheurs ont utilisé un sondage transversal en ligne auprès des résidents en chirurgie plastique du Canada pour évaluer les répercussions de la COVID-19 sur l'exposition clinique, l'expérience de l'enseignement virtuel et les conséquences à long terme de la COVID-19 pour la formation en chirurgie. RÉSULTATS: La présente étude incluait 61 résidents en chirurgie plastique (pour un taux de participation de 40%). Les modes d'enseignement couramment utilisés pendant la COVID-19 incluaient les séminaires en ligne (95%) et les ateliers (58%). Les séances d'enseignement étaient efficaces si elles étaient structurées autour de cas de patients (72%), enregistrées (66%) et se limitaient à une heure (64%). Les réactions étaient mitigées quant aux séances de formation en ligne. Les résidents ont déclaré se sentir reconnaissants (54%), motivés (38%), enthousiastes (28%), dépassés (41%), poussés à participer (23%) et anxieux (13%). Beaucoup moins de résidents avaient l'impression que leur exposition clinique avait été suffisante pendant les restrictions liées à la pandémie (21%) qu'auparavant (72%; p<0,001). Dans l'ensemble, 87% des résidents trouvaient que la pandémie avait un effet négatif sur leur formation, l'acquisition de leurs compétences chirurgicales, leurs projets de surspécialité et leurs perspectives professionnelles. CONCLUSIONS: Pendant la première vague de COVID-19, les résidents ont dû composer avec des modifications à leurs possibilités de formation, qui ont donné lieu à des émotions positives et négatives et à des inquiétudes quant à l'acquisition de leurs habiletés chirurgicales et aux répercussions sur leur plan de carrière. Il est intéressant de caractériser les répercussions précoces sur la formation en résidence pour déterminer les occasions de changement, car l'effet global de la pandémie se poursuit et demeure incertain.

Assessment of eye closure and blink with facial palsy: A systematic literature review.

Facial palsy can cause the impairment of eye closure and affect blink, ocular health, communication, and esthetics. Dynamic surgical procedures can restore eye closure in patients with decreased facial nerve function. There are no standardized measures of voluntary and spontaneous eye closure that are used to evaluate the outcomes of blink restoration procedures. The purpose of this systematic literature review was to identify the measures used to assess normal and abnormal eye closure and blinking in patients with facial palsy. A literature search of the PubMed database using the keyword "facial nerve/surgery" was conducted. Only English language articles that pertain to the use of facial paralysis assessment systems published in the past 20 years, which involve eyelid closure were included. There were 57 articles that used a facial paralysis classification system with an eyelid closure component: House-Brackmann Facial Nerve Grading Scale (n = 43, 67%); Sunnybrook Facial Grading Scale (n = 9); palpebral fissure heights (n = 4), and the electronic clinician-graded facial function tool (n = 3) and three additional measures were reported once. Although the Terzis and Bruno Scoring System, blink ratio, and electronic, clinician-graded facial function scale(eFACE) Clinician-Graded Scoring System were valid measures of eyelid closure, there was no one comprehensive eye assessment that demonstrated all aspects of eye closure in facial palsy, which include closure amplitude, spontaneity, and quality of life. For blink assessment, eFACE is the most comprehensive tool currently available and recommended to be used with a patient-reported quality of life supplement that captures the specific domains related to facial nerve dysfunction.