Experience of a fellowship in spinal surgery: a quantitative analysis.

OBJECTIVES: The objective of our paper was to ascertain the self-reported competency level of surgeons who had completed a 1-year spine fellowship versus those who had not. Our secondary objective was to determine whether there was any difference between orthopaedic and neurosurgeons. METHODS: A 60 question online questionnaire was provided to AOSpine Europe members for completion online. RESULTS: 289 members provided a response, of which 64% were orthopaedic surgeons and 31% neurosurgeons (5% did not specify). Eighty (28%) had completed a 1-year fellowship. Theoretical and practical knowledge of the management of spinal deformity was the greatest difference seen upon completing a fellowship. Multiple elective and emergent conditions were demonstrated to have a significant difference upon completion of a fellowship. There was no difference between orthopaedic surgeons and neurosurgeons. CONCLUSIONS: In order to provide an efficient and safe service covering the broad spectrum of spinal pathology, a formal spine fellowship, ideally with a formal curriculum, should be considered.

Experimental and clinical methods used for fat volume maintenance after autologous fat grafting.

Management of soft tissue deficits resulting from congenital abnormalities, trauma, systemic disease, and tumors is a particularly challenging field of plastic and reconstructive surgery. Fat grafting, a technique traditionally used in the correction of facial asymmetry, is commonly seen in aesthetic procedures which use the grafted fat for soft tissue augmentation and recontouring. Despite its widespread use in reconstruction and aesthetic surgery, therapeutic modalities applied in fat grafting are crude and the results of this intervention are unpredictable. The aim of this review was to present the most recent evidence regarding experimental studies and designs which confirmed or disproved fat volume expansion or fat maintenance after autologous fat grafting.

Earfold™: A combined approach with conchal bowl reduction.

BACKGROUND: Prominent ear deformity is common amongst the human population and is partly due to underdevelopment of the antihelical fold, a prominent conchal bowl, or both. Recently, the senior author described a minimally invasive technique for changing the shape of the antihelical fold using the Earfold™ implant (Allergan plc, Dublin, Ireland). However, there is still a paucity of data regarding outcomes from combing this approach with surgical techniques to correct conchal bowl hypertrophy. OBJECTIVES AND METHODS: Questionnaire-based study evaluating outcomes in consecutive patients undergoing treatment with Earfold™ and conchal bowl reduction. Patient reported outcome measures were assessed with a validated questionnaire. Data on complications were obtained from the patient's case notes and free-text sections of the questionnaire. RESULTS: Completed questionnaires were received from 8 patients out of a total of 18 who underwent the combination treatment (44% response rate). Statistically significant differences were noted in nearly all questions (18/19) relating to changes in ear appearance as a result of the surgery, with all patients being satisfied following the combined procedure. Improvements in subjective outcomes were compared to previous studies evaluating treatment with Earfold™. CONCLUSIONS: The Earfold™ implant can be combined safely with other otoplasty techniques to achieve a good outcome in a carefully selected patient population.

Management of refractory haematuria following radiation therapy and recurrent adenocarcinoma of the prostate with fluoroscopic-guided selective pelvic embolization.

Haematuria is a known complication of prostatic malignancy and in severe cases can be unresponsive to bladder irrigation and endoscopic interventions. This report describes selective angiographic embolization as a means of haemorrhage control in adenocarcinoma of the prostate. A patient with locally advanced prostatic adenocarcinoma and prior history of prostate brachytherapy, androgen deprivation therapy and chemotherapy presented with persistent haematuria that did not respond to endourological intervention. He was successfully treated with selective embolization of the vesical and prostatic vessels under fluoroscopic guidance. Angiographic embolization represents a safe and effective means of achieving haemostasis in patients not fit for surgerywho would otherwise be resigned to terminal care treatment.