Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review.

Introduction: Soft-tissue thumb defects are common reconstructive challenges, the main goals being restoration of tactile sensibility, range of movement, pulp padding, length, and cosmesis. The reverse-flow dorsoulnar and dorsoradial collateral artery flaps are homodigital flaps used to cover both distal dorsal and volar thumb defects. These flaps can be used as compound flaps including skin, fat, and/or nerves. As there is no critical analysis of these studies, this study aims to create a synthesized comprehensive systematic review. Methods: Systematic review was performed using the databases PubMed, Embase, and Medline. Eligible studies followed the inclusion criteria: English language and all studies published to date. The primary outcome was flap survival. Other data collected included anatomical area of the defect, flap constituents and dimensions, donor-site closure and complications, transfer method, reoperation, revision, and functional outcomes. Results: A total of 19 articles incorporating 189 flaps met the inclusion criteria. These flaps were categorized and analyzed as dorsoradial (50%), dorsoulnar (39%), and turnover flaps (11%). Dorsoradial flaps were used in fasciocutaneous fashion alone. Partial flap failures occurred in five cases. Dorsoulnar flaps were used as fasciocutaneous or as osteocutaneous flaps. Complete flap failure was reported in one patient alone, whereas partial necrosis was reported in four patients. Adipofascial turnover flaps had two partial flap failures reported but no complete failures. The overall complete and partial flap failure rates were 0.5 and 6.5%, respectively. Conclusion: Reverse-flow homodigital random or axial-based flaps provide a reliable means of reconstruction for soft-tissue defects with reasonable success rate and good functional outcomes. They have a consistent anatomy with a good potential for personalization and therefore increased versatility.

Changes in attitudes towards telemedicine in acute burn care following the Covid-19 pandemic.

BACKGROUND: Telemedical referrals after burn injury had been shown to be advantageous over telephone referrals for multiple reasons, however there were several key barriers towards complete implementation. The Covid-19 pandemic facilitated the adoption of telemedicine to ensure the safety of both clinicians and patients. Due to the circumstances, it was unclear whether the pre-pandemic barriers still existed despite the complete implementation of telemedicine. This study aims to evaluate clinicians' views about the barriers towards implementation of a specific telemedicine system for burns referrals, and their changing attitudes following the pandemic, to identify key domains for improvement in current and future telemedicine systems. METHODS: A questionnaire was created to evaluate the attitudes of referring clinicians towards telemedicine, following literature searches and administration of a pilot questionnaire. This was administered via telephone to staff working in EDs and MIUs which referred to the South-West United Kingdom Burns Network using the Medical Data Solutions and Services (MDSAS) system, in both 2019 and 2022. A statistical analysis was performed to compare the attitudes of clinicians towards telemedicine both pre- and post-pandemic. RESULTS: 100 respondents completed the survey in 2019 and 70 in 2022, with similar demographics of respondents. Out of the twelve barriers identified, the lack of reliable Wi-Fi and need to duplicate notes were identified as the main obstacles to implementation in both time periods. In both years, the single greatest barrier reported was poor access to reliable Wi-Fi (p = 0.944). Miscommunication between clinicians using the system, inadequate numbers of devices and financial constraints were identified less frequently as barriers in 2022 than 2019 (p = 0.005, p = 0.047 and p < 0.001 respectively). However, significantly more respondents reported time pressures when waiting for a response to their telemedicine referral in 2022 (p = 0.022). CONCLUSION: Overall, clinicians displayed a positive attitude towards the MDSAS system for acute burns, with clinicians identifying fewer concerns with the system following the Covid-19 pandemic. However, concerns over the time pressures that this telemedicine system places on the referring clinician and existing Wi-Fi infrastructure persist. Further streamlining of the system and investment in internet access is recommended, with continued input from all stakeholders.

Re-Engineering Data Processing Workflow to Automate Abbreviations Audit of Clinical Documentation.

In KK Women's and Children's Hospital (KKH), clinical case notes audits are conducted quarterly for compliance of approved acronym usage. Existing process involves the retrieval of mixed hardcopy and electronic case notes for referencing manually to the list of approved abbreviations by clinical coder. Through the use of process re-engineering and excel application, audit coverage can thus be expanded with reduction in human dependency and errors with significant resultant savings in time spent.