Aboard the Smile Train: Outcomes of Primary Cleft Palate Repair at a Tertiary Care Center: À bord du Smile Train : les résultats cliniques de réparations de fentes palatines dans un centre de soins tertiaires.

INTRODUCTION: Cleft palate repair is considered to be a safe procedure, yet still carries a 5% to 30% risk of complications. This study sought to assess the outcomes of this procedure in a high-burden Asian country that partners with the Smile Train to perform cleft surgeries. METHODS: The Aga Khan University medical records database was queried for pediatric patients undergoing cleft surgery between 2014 and 2017. Data were abstracted from the patient medical records, and details of the clinical, demographic factors, and postoperative outcomes were assessed. RESULTS: Among 142 patients with orofacial clefts, 102 (72%) underwent primary cleft palate repair, one-third (n = 36, 35%) of whom were operated as part of the Smile Train. The median preoperative hemoglobin was 11.4 g/dL (interquartile range: 10.7-12.0 g/dL), whereas the median weight was 8.3 kg (7.7-11.4 kg). Nearly two-thirds (n = 64, 63%) of the cohort underwent preoperative cardiology screening, with only a minority undergoing orthodontic treatment (n = 6, 6%). Approximately 15% (n = 15) of patients experienced a postoperative complication, most often a fistula (n = 11, 73%). On multivariable analysis, with each unit increase in hemoglobin levels, there was a 50% reduction in the odds of experiencing a complication (odds ratio: 0.51, 95% CI: 0.28-0.87). There were no in-patient deaths among the cohort. CONCLUSION: The results of the current study provide useful information to key stakeholders including patients, plastic surgeons, and policy makers on the outcomes of cleft palate repair in a developing country.

INTRODUCTION: La réparation des fentes palatines est considérée comme une intervention sécuritaire, mais comporte un risque de complications de 5 % à 30 %. La présente étude vise à évaluer les résultats de cette intervention dans un pays asiatique au fardeau élevé où les partenaires de Smile Train corrigent des fentes palatines. MÉTHODOLOGIE: Les chercheurs ont fouillé la base de données des dossiers de l'université Aga Khan pour en extraire les patients pédiatriques qui ont subi une intervention de fente palatine entre 2014 et 2017. Ils ont résumé les données des dossiers médicaux des patients et évalué le détail des facteurs cliniques et démographiques ainsi que les résultats postopératoires. RÉSULTATS: Sur les 142 patients ayant une fente labiopalatine, 102 (72 %) ont subi une réparation palatine primaire, dont le tiers a été opéré (n = 36, 35 %) par l'équipe de Smile Train. L'hémoglobine préopératoire médiane était de 11,4 g/dl (ratio interquartile de 10,7 à 12,0 g/dl), et le poids médian, de 8,3 kg (7,7 g à 11,4 kg). Près des deux tiers des membres de la cohorte (n = 64, 63 %) ont subi un dépistage préopératoire, et seule une minorité a suivi un traitement orthodontique (n = 6, 6 %). Environ 15 % des patients (n = 15) ont souffert d'une complication postopératoire, la plupart du temps sous forme de fistule (n = 11, 73 %). À l'analyse multivariée, à chaque nouvelle unité d'hémoglobine, le risque de complication diminuait de 50 % (rapport de cotes 0,51, IC à 95 %, 0,28 à 0,87). Aucun patient hospitalisé n'est décédé au sein de la cohorte. CONCLUSION: Les résultats de la présente étude fournissent de l'information utile aux principaux intervenants, y compris les patients, les plasticiens et les décideurs, sur les résultats des réparations de la fente palatine dans un pays industrialisé.

Use of Cephalic Vein for Venous Anastomosis in Head and Neck Reconstruction: A Case Series.

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap. Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon. Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients. Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck.

Versatility of the Anterolateral Thigh Flap: An AKUH experience.

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects of various soft tissue and bulk requirements. Adequate outcomes were achieved pertaining to the reconstruction of the soft tissue defects. Anterolateral thigh flap can be used to reconstruct soft tissue defects almost anywhere and almost of any complexity.