Assessment of x-ray efficacy for intraoperative microneedle retrieval using a cadaveric model.

INTRODUCTION: Institutional protocols often mandate the use of x-rays when a microneedle is lost intraoperatively. Although x-rays can reliably show a macroneedle, the benefit of x-rays in detecting microneedles in human tissues has not been established as available data on this topic are investigated in anthropometric models. The current study aims to evaluate whether x-rays can reliably detect retained microneedles in a human cadaveric model. We hypothesize that microneedles would be detected at a significantly lower rate than macroneedles by x-ray in human tissues. MATERIALS AND METHODS: Needles ranging from 4-0 to 10-0 were placed randomly throughout a cadaveric hand and foot. Each tissue sample was x-rayed using a Fexitron X-Ray machine, taking both anteroposterior and lateral views. A total of six x-ray images were then evaluated by 11 radiologists, independently. The radiologists circled over the area where they visualized a needle. The accuracy of detecting macroneedles (size 4-0 to 7-0) was compared with that of microneedles (size 8-0 to 10-0) using a chi-square test. RESULTS: The overall detection rate for the microneedles was significantly lower than the detection rate for macroneedles (13.5% vs 88.8%, p < .01). When subcategorized between the hand and the foot, the detection rate for microneedles was also significantly lower than the rate for macroneedles (hand: 7.6% for microneedles, 93.2% for macroneedles, p < .01; foot: 19.5% for microneedles, 84.4% for macroneedles, p < .01). The detection rate, in general, significantly decreased as the sizes of needles became smaller (7-0:70.5%, 8-0:18.2%, 9-0:16.7%, 10-0:2.3%, p < .01). CONCLUSION: X-rays, while useful in detecting macroneedles, had a significantly lower rate of detecting microneedles in a cadaveric model. The routine use of x-rays for a lost microneedle may not be beneficial. Further investigation with fresh tissue and similar intraoperative x-ray systems is warranted to corroborate and support these findings.

Post-mastectomy Breast Reconstruction With Gas vs Saline Tissue Expanders: Does the Fill Type Matter?

The most common reconstruction technique following mastectomy is a 2-stage technique that involves tissue expansion followed by definitive implant-based reconstruction (IBR). Tissue expanders (TEs) have classically used saline for initial fill; however, TEs with an initial gas fill (GTE)-including the CO2-based AeroForm (AirXpanders, San Francisco, CA) TE and TEs initially filled with atmospheric air-have been increasingly used in the past decade. We aimed to compare the outcomes in breast reconstruction for tissue expanders initially filled with saline vs gas. PubMed was queried for studies comparing gas- and saline-filled tissue expanders (STEs) used in IBR. A meta-analysis was performed on major postoperative outcomes and the required expansion and definitive reconstruction time. Eleven studies were selected and included in the analysis. No significant differences existed between tissue expansion with GTEs vs STEs for 11 of the 13 postoperative outcomes investigated. Out of the complications investigated, only the risk of infection/cellulitis/abscess formation was significantly lower in the GTE cohort (odds ratio 0.62; 95% CI, 0.47 to 0.82; P = .0009). The time to definitive reconstruction was also significantly lower in the GTE cohort (mean difference [MD], 45.85 days; 95% CI, -57.80 to -33.90; P < .00001). The total time to full expansion approached significance in the GTE cohort (MD, -20.33 days; 95% CI, -41.71 to 1.04; P = .06). A cost analysis considering TE cost and infection risk determined that GTE use saved a predicted $2055.34 in overall healthcare costs. Surgical outcomes for both fill types were predominantly similar; however, GTEs were associated with a significantly decreased risk of postoperative infection compared to saline-filled TEs. GTEs could also reduce healthcare expenditures and require less time until definitive reconstruction after placement.

Scaling up Surgical Capacity in Kenya: The Kenya Hospital Assessment Tool (K-HAT).

INTRODUCTION: Although substantial progress has been achieved to bring surgical care to the forefront of global health discussions, a number of low-and middle-income countries are still in the process of developing a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). This paper describes the initial step toward the development of the NSOAP through the creation of the Kenya National Hospital Assessment Tool (K-HAT). METHODS: A study protocol was developed by a multisectoral collaborative group that represented the pillars of surgical capacity development in Kenya. The K-HAT was adapted from two World Health Organization (WHO) tools: the Service Availability and Readiness Assessment tool and the Situational Analysis Tool. The survey tool was deployed on Open Data Kit, an open-source electronic encrypted database. This new locally adapted tool was pilot tested in three hospitals in Kenya and subsequently deployed in Level 4 facilities. RESULTS: Eighty-nine questions representing over 800 data points divided into six WHO Health Systems Strengthening sections comprised the K-HAT which was deployed to over 95% of Level 4 hospitals in Kenya. When compared to the WHO Service Availability and Readiness Assessment tool, the K-HAT collected more detailed information. The pilot test team reported that K-HAT was easy to administer, easily understood by the respondents, and that it took approximately 1 hour to collect data from each facility. CONCLUSIONS: The K-HAT collected comprehensive information that can be used to develop Kenya's NSOAP.