Building relationships to connect cancer researchers with community members: 'bench to community pipeline'.

PURPOSE: Partnerships between researchers and community members and organizations can offer multiple benefits for research relevance and dissemination. The goal of this project was to build infrastructure to create bidirectional relationships between University of Wisconsin Carbone Cancer Center (UWCCC) researchers and community educators in the Division of Extension, which connects the knowledge and resources of the university to communities across the state. METHODS: This project had three aims: (1) create linkages with Extension; (2) establish an in-reach program to educate and train researchers on the science of Community Outreach and Engagement (COE); and (3) identify and facilitate collaborative projects between scientists and communities. Survey and focus group-based needs assessments were completed with both researchers and Extension educators and program activity evaluations were conducted. RESULTS: Most Extension educators (71%) indicated a strong interest in partnering on COE projects. UWCCC faculty indicated interest in further disseminating their research, but also indicated barriers in connecting with communities. Outreach webinars were created and disseminated to community, a "COE in-reach toolkit" for faculty was created and a series of "speed networking" events were hosted to pair researchers and community. Evaluations indicated the acceptability and usefulness of these activities and supported continuation of collaborative efforts. CONCLUSION: Continued relationship and skill building, along with a sustainability plan, is critical to support the translation of basic, clinical, and population research to action in the community outreach and engagement context. Further incentives for faculty should be explored for the recruitment of basic scientists into community engagement work.

Home-based rehabilitation using a soft robotic hand glove device leads to improvement in hand function in people with chronic spinal cord injury:a pilot study.

BACKGROUND: Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual's capability to perform essential activities of daily living (ADL). OBJECTIVE: This pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB. METHODS: Fifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale. RESULTS: The TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm, p <0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up. CONCLUSIONS: Self-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI. TRIAL REGISTRATION NUMBER: Trial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN98677526.

A Qualitative Study of Patients' Lived Experiences of Free Tissue Transfer for Diabetic Foot Disease.

Background: Free tissue transfer (FTT) for reconstruction of diabetic foot disease (DFD) is an emerging field to preserve the lower limb within this patient group. The design of future quantitative research and clinical services in this area must consider the needs, expectations and concerns of patients. This qualitative study explores patient experiences of FTT for reconstruction of DFD. Methods: Semistructured interviews were conducted to explore patients' lived experiences of FTT for DFD. A purposive sampling strategy identified six patients who underwent FTT for recalcitrant DFD between September 2019 and December 2021 in a single center in the United Kingdom. Results: Three experiential themes emerged. Theme 1: "negative lived experiences of living with DFD" included frustration with the chronic management of nonhealing ulcers and fear regarding limb amputation. Theme 2: "surgery related concerns" included fears of reconstructive failure and subsequent amputation, as well as foot cosmesis and donor-site morbidity. Theme 3: "positive lived experiences following reconstruction" included the positive impact the reconstruction had on their overall life and diabetic control. All patients would repeat the process to obtain their current results. Conclusions: This qualitative study provides first-hand insight into the lived experience of FTT for DFD, exploring both the negative and positive experiences and reasons for these. We found that FTT for DFD can be positively life-changing for affected individuals.

Management of metacarpal shaft fractures.

Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality. Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence. Results: A total of 793 patients (75% male, 25% female) with 897 MSFs were included, comprising 0.1% of 837,212 ED attendances. The annual incidence of MSF was 40 per 100,000. The median age was 27 years (IQR 21 to 41); the highest incidence was in men aged 16 to 24 years. Transverse fractures were the most common. Over 80% of all fractures were treated non-surgically, with variation across centres. Overall, 12 types of non-surgical and six types of surgical treatment were used. Fracture pattern, complexity, displacement, and age determined choice of treatment. Patients who were treated surgically required more radiographs and longer radiological and outpatient follow-up, and were more likely to be referred for therapy. Complications occurred in 5% of patients (39/793). Most patients attended planned follow-up, with 20% (160/783) failing to attend at least one or more clinic appointments. Conclusion: MSFs are common hand injuries among young, working (economically active) men, but there is considerable heterogeneity in treatment, rehabilitation, and resource use. They are a burden on healthcare resources and society, thus further research is needed to optimize treatment.

Outcomes of flap reconstruction for diabetic foot ulcers: a systematic review and meta-analysis of Clinical Studies.

BACKGROUND: People with diabetic foot ulcers (DFU) are at risk of major amputation, which is associated with a high mortality rate (exceeding 50% at five years) and reduced quality of life. We hypothesise that flap reconstruction of diabetic foot ulcers improves patient outcomes in comparison to standard treatment modalities including major amputation. METHODS: MEDLINE, EMBASE, the Cochrane Library and grey literature were searched on 9 th February 2022. Comparative and single-arm studies reporting outcomes of DFU treated with local, regional or free flaps including function, limb loss, mortality, and flap failure were included. Risk of bias was assessed and meta-analysis of proportions was performed. RESULTS: 3,878 records were retrieved, of which 45 met the inclusion criteria, including 1,681 patients who underwent flap reconstruction of DFU. Free flaps were most commonly performed (n = 1,257, 72%). Only one study utilised a verified functional outcome measure. At 12 months, the mortality rate was 6.35% (95% C.I. 3.89 - 10.20), limb loss rate was 11.39% (95% C.I. 7.02 - 17.96) and the free flap failure rate was 9.95% (95% C.I. 8.19 - 12.05). All studies were at high risk of bias. A comparative meta-analysis of interventions was not performed due to study method and outcome heterogeneity. CONCLUSIONS: There is short-term evidence that flap reconstruction (including microsurgical transfer) has low mortality, limb loss and flap failure rates. However, there are limited high-quality comparative studies, and uncertainty remains regarding the outcome of DFU flap reconstruction in comparison to other treatments.

Unusual twisting of a reconstructed FDP tendon of the little finger after spontaneous attrition rupture on the hamate bone: a case report.

We describe a case of attrition rupture of flexor digitorum profundus tendon of the right little finger in a 64-year-old lady caused by a prominent hook of hamate. The tendon was reconstructed primarily by palmaris longus tendon graft and was complicated by tendon graft twisting by scar tissue, resulting in the inability to fully extend the finger.

Free functional muscle transfer for upper limb paralysis - A systematic review.

BACKGROUND: Functional restoration of upper limb paralysis represents a major reconstructive challenge. Free functional muscle transfer (FFMT) enables reanimation in patients with a lack of local donor tissues or delayed presentation. This systematic review summarises the evidence for FFMT in the reconstruction of upper limb paralysis. METHODS: A comprehensive search of MEDLINE and EMBASE was performed with a systematic review using methodology adapted from the Cochrane Handbook and the PRISMA statement. Data from included studies were compiled and narratively synthesised. Studies were assessed for risk of bias. RESULTS: A total of 1155 records were screened, with 39 observational studies of 904 patients included. The most common aetiology was brachial plexus injury (736, 81.4%). Mean time from injury to intervention was 26 months. Restoration of elbow flexion was the commonest reconstructive goal. The most common donor muscle was gracilis (91.5%). Reported outcomes were heterogeneous with patient-reported outcome measures (PROMs) available in only 7 of 39 studies. Nearly half of FFMTs had a post-operative MRC grade of <4 and 18.1% had an MRC <3. Mean flap failure rate was 3.6% (range 0-10.5%). All studies were at high risk of bias. CONCLUSIONS: FFMT may be an effective surgical intervention for upper limb paralysis; however, the current evidence has significant shortcomings. There is no consensus regarding outcome measures nor is it possible to identify prognostic factors for its effectiveness. This review highlights a need for improved study design with pre-operative assessment, standardisation in outcome reporting, and the use of PROMs to determine the effectiveness of FFMT in upper limb paralysis.

Variants in ALDH1A2 reveal an anti-inflammatory role for retinoic acid and a new class of disease-modifying drugs in osteoarthritis.

More than 40% of individuals will develop osteoarthritis (OA) during their lifetime, yet there are currently no licensed disease-modifying treatments for this disabling condition. Common polymorphic variants in ALDH1A2, which encodes the key enzyme for synthesis of all-trans retinoic acid (atRA), are associated with severe hand OA. Here, we sought to elucidate the biological significance of this association. We first confirmed that ALDH1A2 risk variants were associated with hand OA in the U.K. Biobank. Articular cartilage was acquired from 33 individuals with hand OA at the time of routine hand OA surgery. After stratification by genotype, RNA sequencing was performed. A reciprocal relationship between ALDH1A2 mRNA and inflammatory genes was observed. Articular cartilage injury up-regulated similar inflammatory genes by a process that we have previously termed mechanoflammation, which we believe is a primary driver of OA. Cartilage injury was also associated with a concomitant drop in atRA-inducible genes, which were used as a surrogate measure of cellular atRA concentration. Both responses to injury were reversed using talarozole, a retinoic acid metabolism blocking agent (RAMBA). Suppression of mechanoflammation by talarozole was mediated by a peroxisome proliferator-activated receptor gamma (PPARγ)-dependent mechanism. Talarozole was able to suppress mechano-inflammatory genes in articular cartilage in vivo 6 hours after mouse knee joint destabilization and reduced cartilage degradation and osteophyte formation after 26 days. These data show that boosting atRA suppresses mechanoflammation in the articular cartilage in vitro and in vivo and identifies RAMBAs as potential disease-modifying drugs for OA.

Peripheral nerve decompression in the upper limb in spinal cord injury: experiences at the National Spinal Injuries Centre, UK.

STUDY DESIGN: Retrospective cohort study of consecutive upper limb peripheral nerve decompressions in SCI patients. All procedures were performed at a single National Spinal Injuries Centre between 2015 and 2019. OBJECTIVES: Entrapment neuropathies in the upper limb are underdiagnosed and undertreated in patients with spinal cord injury (SCI). This cohort study represents the first published outcomes of upper limb peripheral nerve decompression in patients with SCI. SETTING: National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, UK. METHODS: Data collected from electronic medical records included patient demographics, procedures performed, length of inpatient stay, nerve conduction studies, and patient satisfaction. Patients were also contacted by telephone to complete a questionnaire that included patient satisfaction, the NHS 'Friends & Family Test' and validated patient-reported outcome measures (PROMs). RESULTS: Thirty-four decompression procedures (24 carpal tunnel, 10 cubital tunnel) were performed in 24 patients (14 with paraplegia, 10 tetraplegia). 71% of patients had pre-operative nerve conduction studies: 71% of these were graded as severe. Mean length of stay was 14 nights. 91% of patients were satisfied with their procedure at clinic follow-up. Mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom scores were reduced from 3.7 to 1.3 pre- vs. post-operatively (p < 0.001). Patient Reported Ulnar Nerve Evaluation (PRUNE) scores reduced from 49.4 to 23.0 (p = 0.01). CONCLUSION: In our experience, SCI patients tend to present with severe upper limb nerve entrapment syndromes. Operative management is well tolerated with low risk of complications and can result in marked improvements in symptoms and function.

Active proportional electromyogram controlled functional electrical stimulation system.

Neurophysiological theories and past studies suggest that intention driven functional electrical stimulation (FES) could be effective in motor neurorehabilitation. Proportional control of FES using voluntary EMG may be used for this purpose. Electrical artefact contamination of voluntary electromyogram (EMG) during FES application makes the technique difficult to implement. Previous attempts to date either poorly extract the voluntary EMG from the artefacts, require a special hardware or are unsuitable for online application. Here we show an implementation of an entirely software-based solution that resolves the current problems in real-time using an adaptive filtering technique with an optional comb filter to extract voluntary EMG from muscles under FES. We demonstrated that unlike the classic comb filter approach, the signal extracted with the present technique was coherent with its noise-free version. Active FES, the resulting EMG-FES system was validated in a typical use case among fifteen patients with tetraplegia. Results showed that FES intensity modulated by the Active FES system was proportional to intentional movement. The Active FES system may inspire further research in neurorehabilitation and assistive technology.

Free Dorsal Toe Flap for Reconstruction of the Hallux.

Soft tissue defects of the hallux represent a reconstructive challenge. Traditional options include regional flaps based on the first dorsal metatarsal artery (FDMA). However, the resultant bulky neo-hallux and contouring defect of the donor site are significant limiting factors. Here, we present the case of a young male athlete who underwent successful reconstruction of a dorsal defect of the hallux, with open exposed joint, using a free flap from the contralateral toe. We believe this is the first report of a free dorsal toe flap to reconstruct a defect of the hallux. The flap was based on the lateral dorsal digital artery, an extension of the FDMA. The donor site was reconstructed using a full thickness skin graft from the groin. Postoperatively, the flap survived completely, and both the recipient and donor sites healed without complication. There was no contour abnormality and he was able to wear his normal shoes and ambulate normally by week 3. Although the dorsal metatarsal artery perforators that supply the dorsal skin of the forefoot have been well described, there have been limited studies investigating the vascular supply of the dorsal skin overlying the hallux distally. Our experience shows that it is possible to raise a free dorsal toe flap based on the lateral dorsal digital artery only. This flap represents the ideal like-for-like reconstruction for soft tissue defects of the hallux.

Aesthetic restoration of Poland's syndrome in a male patient using free anterolateral thigh perforator flap as autologous filler.

We report a case of a male patient with Poland's anomaly who was reconstructed with a free anterolateral thigh perforator flap. The flap was used successfully as an autologous filler to recreate the anterior axillary line and correct the chest contour deformity. The use of the free anterolateral thigh perforator flap is an excellent choice as an autologous filler to correct mild and moderate deformity in male Poland's syndrome, carrying low morbidity and leaving both minimal scarring and functional sequelae.

Costs and renumeration of osteomyelitis treatment involving free flaps: implications of return to theatre.

Aim: This study aimed to define the costs of surgical management of chronic osteomyelitis where free tissue transfer was required in addition to debridement of bone, particularly the increased costs incurred by a return to theatre. We hypothesised that there would be a significantly greater cost when patients required re-exploration for vascular compromise. Method: We retrospectively analysed the costs of a consecutive series of sixty patient episodes treated at the Bone Infection Unit in Oxford from 2012 to 2015. Treatment involved excision of osteomyelitis with free tissue transfer for immediate soft tissue cover. We compared the costs of uncomplicated cases with those who returned to theatre and determined the profit / loss for the hospital from renumeration through the UK National Health Service Tariff Structure. Results: Hospital income according to UK HRG tariff was compared to the actual cost of treatment and these 60 cases were significantly underfunded overall (P < 0.005). In just 1 case, the cost to the hospital was completely covered by tariff. Six patients (10%) returned to theatre for urgent flap re-exploration with five flaps salvaged and one failed, requiring another free flap reconstruction (1.7%). These six patient episodes had a significantly higher mean cost compared to the uncomplicated cases. The average financial loss to the hospital for patients who did return to theatre was £19401 (range £8103 to £48380) and in those who did not was £9600 (range - £600 to £23717). The case requiring further free tissue transfer cost a total of £74158, £48380 more than the hospital was paid: the most extreme discrepancy. The overall loss for this group of 60 patients was £610 090. Conclusions: Surgery for chronic osteomyelitis is multidisciplinary, complex and therefore expensive with a significant risk of complications. However, this study demonstrates that the hospital currently makes a financial loss on almost all patients but especially if flap complications occur. This study has implications for the long term viability of specialist units treating this important disease.

Isolated axillary lymph node metastasis in oesophageal adenocarcinoma.

Oesophageal adenocarcinoma metastatic to the axilla is a rare occurrence. The authors present a case of a woman who developed an axillary metastasis from a completely excised oesophageal adenocarcinoma with no prior evidence of nodal disease. With aggressive local treatment, including multiple local operations and radiotherapy, she remains alive and disease-free 12 years after her diagnosis following surgical resection of her axillary metastasis with adjuvant radiotherapy. This case report suggests that there are occasions when aggressive local treatment of apparently isolated metastases can result in a cure.

Necrotising fasciitis: a sequelae of varicella zoster infection.

Necrotising fasciitis (NF) can complicate varicella zoster virus in children. This is rare and has not previously been reported in the plastic surgery literature. We report a case of a female toddler who developed necrotising fasciitis secondary to chicken pox. Her presentation and progress are reported, the diagnosis of necrotising fasciitis in children and the small number of case series and case control studies are discussed.