Common practices in patient care after mammaplasty and perioperative safety measures to prevent thromboembolic events - An observational study across all continents.

BACKGROUND: Most plastic surgeons have encountered complications related to venous thromboembolism in their profession. However, considerable deficits in risk assessment and prophylaxis have been described. As outpatient procedures are increasing, so are concerns with regard to patient safety. The presented study investigates the global distribution pattern of patient care for mammaplasties and compares international common practices of perioperative safety measures to prevent thromboembolic events. METHODS: A questionnaire was sent to over 5000 plastic surgeons in 77 countries. The survey inquired about surgeon demographics, standard perioperative safety measures, type of thrombosis prophylaxis, and international patterns of patient care. The results were evaluated and correlated with the evidence-based literature. RESULTS: A total of 1431 surveys were gathered (response rate: 29%). The gathered data show international disparity with regard to inpatient vs. outpatient care. Mammaplasties in the USA are being performed as same-day surgeries in > 80% of cases, while globally inpatient and outpatient procedures are distributed evenly. Also, we found no international consensus with regard to safety measures to prevent thromboembolic events. Geographical regions showed differences with regard to type, dosage, timing, and duration of thrombosis prophylaxis. CONCLUSIONS: International practice patterns remain incoherent. This highlights the need for coherent and detailed global guidelines for plastic surgical interventions. High-quality studies are needed in order to establish evidence-based, standardized, and universally applicable practice guidelines.

Episiotomy: history, present and future - a review.

Childbirth has always carried traumatic stress to the woman's body. To deliver with less perineal trauma, obstetricians have used episiotomies. Episiotomy is still a common practice despite the controversy regarding its use. Weighing the risks and benefits, the scientific literature supports its selective use. With the worldwide trend to reduce the rate of episiotomy, several techniques have been proposed to achieve that. However, further research is still needed to prove their efficacy. This review will shed light on the historical background of episiotomy, its different techniques, indications, and the future of its practice.

The skull vibration-induced nystagmus test: A useful vestibular screening test in children with hearing loss.

INTRODUCTION: Skull-Vibration-Induced-Nystagmus Test (SVINT), a non-invasive first line examination test, stimulates both otolith and canal structures and shows instantaneously a vestibular asymmetry. This study aimed to analyze the SVINT results observed in children with hearing loss (HL) amplified with hearing aids (HA) or unilateral cochlear implant (uCI) and healthy children. MATERIAL AND METHODS: This case-control study compared the results of SVINT, caloric test (CaT) and video head-impulse-test (VHIT) in 120 controls to 30 children with HA and 30 with uCI, aged 5-18 years old. SVINT was recorded with videonystagmography after very high frequency (VHF) stimulation of mastoids and vertex. RESULTS: SVINT results were non-pathological in 98% of the control group but modified in the HL group (P-value=0.04). In uCI participants, 13.3% had a bilateral weakness (BW) and 16.7% had a unilateral weakness (UW). In the HA group, 26.7% had BW, 10% had UW. SVINT was efficient to show a UW (6 out of 7 confirmed cases) but not efficient to show BW (1/12 confirmed cases). CONCLUSION: SVINT can detect unilateral vestibular deficit in the VHF with a sensitivity of 86% and specificity of 96%. The positive predictive value is 75% and negative predictive value is 98%. In the case of bilateral deficit, the SVINT is inoperant. In amplified participants, a UW was equally detected whether using SVINT, CaT or VHIT. SVINT is a well-tolerated and useful test to screen vestibular asymmetry in children with HL when combined with other vestibular tests and shows its complementary at very high frequencies.

Efficacy and safety of inferior turbinates coblation in children.

OBJECTIVE: To assess the effectiveness and safety of coblation in relieving inferior turbinate hypertrophy in children. METHODS: An observational cohort study was undertaken. The severity of allergic rhinitis and the severity and degree of nasal obstruction were assessed using subjective and clinical symptom grading tools, a visual analogue scale, and endoscopy. Any post-operative complications were noted at 1 week, and at 1, 3, 6 and 12 months post-operatively. Data from extended follow-up periods were included when available. The statistical significance of changes in parameter values was assessed using the Wilcoxon signed-rank test. RESULTS: Thirty-two patients were recruited (mean age, 11.28 years; range, 6-17 years). Significant post-operative improvement (p<0.001) was noted in the severity and degree of nasal obstruction. This improvement was maintained after a mean follow-up period of 10.5 months (range, 1 month to 4 years). No mucosal ulceration or adhesion was encountered. Minimal crusting was noted in 8.57 per cent of patients at 1-week follow up. Allergic rhinitis symptoms improved significantly. CONCLUSION: Inferior turbinate reduction by coblation is an effective and safe procedure in children aged six years and older. The positive outcomes seem to be long-lasting.

Vitamins and cutaneous wound healing.

BACKGROUND: Vitamins have long been thought to modulate the various stages of wound healing through a variety of proposed mechanisms. Our goal was to investigate relevant studies examining the role of different vitamins in wound healing. METHODS: MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched for basic science and clinical studies examining the role of vitamins as adjuncts in wound healing. RESULTS: Mechanisms of action for each of the vitamins are reviewed. It was suggested by many of the studies that the major vitamins A, C, E, D, K, and B have demonstrated utility as adjuncts in wound care in basic science and clinical trials. CONCLUSION: There is a vast amount of literature on the effect of vitamins on wound healing at the basic science level. Further understanding and controlled trials will help better understand how to utilize vitamins in wound care. DECLARATION OF INTEREST: None.