Search

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite increased public awareness to dispose of unused narcotics, opioids prescribed postoperatively are retained, which may lead to drug diversion and abuse. This study assessed retention of unused opioids among hand surgery patients and describes disposal methods and barriers. Methods: Participants undergoing hand surgery were given an opioid disposal information sheet preoperatively (N = 222) and surveyed postoperatively to assess disposal or retention of unused opioids, disposal methods, and barriers to disposal. A binomial logistic regression was conducted to assess whether age, sex, pain intensity, and/or the type of procedure were predictors of opioid disposal. Results: There were 171 patients included in the analysis (n = 51 excluded; finished prescription or continued opioid use for pain control). Unused opioids were retained by 134 patients (78%) and disposal was reported by 37 patients (22%). Common disposal methods included returning opioids to a pharmacy (49%) or mixing them with an unwanted substance (24%). Reasons for retention included potential future use (54%), inconvenient disposal methods (21%), or keeping an unfilled prescription (9%). None of the patient factors analyzed (age, sex, type of procedure performed, or pain score) were predictors of disposal of unused narcotics (P >.05). Conclusions: Most patients undergoing hand surgery retained prescribed opioids for future use or due to impractical disposal methods. The most common disposal methods included returning narcotics to a pharmacy or mixing opioids with unwanted substances. Identifying predictors of disposal may provide important information when developing strategies to increase opioid disposal. [ABSTRACT FROM AUTHOR]

Introduction: People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function. Objective: To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function. Design: Prospective cohort study. Participants were followed up for 24 months and completed up to three interviews. Setting: Tertiary care at academic and affiliated Veterans Administration Health Care Centers. Participants: Adults with cervical SCI (n = 35) ages 18 to 80 years with mid‐cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least 6 months post‐injury) and their caregivers (n = 23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery. Interventions: Not applicable. Main Outcome Measure: Semi‐structured interviews about surgical knowledge and experiences. Results: Data were analyzed and three themes were identified. First, providing information about UE surgical options early post‐injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information. Conclusions: Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and health care providers. [ABSTRACT FROM AUTHOR]

Adequate health literacy is essential to navigate the healthcare system and has a major role in peri-operative care and outcomes. Minimal information exists regarding surgeons' understanding of health literacy, clinical implications, and awareness of universal measures of support. This study assessed Canadian surgeons' perceptions of patients' health literacy and their knowledge of available supportive resources. We conducted a cross-sectional study using an electronic survey distributed to surgeons at academic institutions. Data collected included sociodemographics, health literacy knowledge, and practice surrounding the use of supportive measures. Across four Canadian academic institutions (University of Toronto, McMaster University, University of Alberta, and University of Calgary), 35 surgeons from various surgical specialties, including general, plastic, and orthopedic surgery, completed the survey. Approximately 74% of surgeons reported familiarity with the concept "health literacy", but they used general impressions to estimate their patients' health literacy levels. Surgeons' perceptions were that patients who had proficient health literacy represented 50% or less of their practice. However, knowledge of supportive tools for measuring patient health literacy was variable. Surgeons familiar with health literacy spent significantly more time (>15 minutes) counselling patients (38%, p=0.02) and used language at a 10th grade level or less (92%, p=0.04). Common supportive measures included using simple, non-medical terms (97%, n=34), repetition (83%, n=29), and drawing pictures/diagrams (83%, n=29). This study highlights the importance of surgeon awareness of health literacy and how improved awareness may guide patient-surgeon interactions and improve the quality of care. [ABSTRACT FROM AUTHOR]

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve injuries may result in pain, disability, and decreased quality of life (QoL). Pain is an incompletely understood experience and is associated with emotional and behavioral qualities. We hypothesized that pain following peripheral nerve surgery could be predicted by changes in emotions or QoL postoperatively. Methods: Using prospectively collected data, a retrospective study design was used to evaluate the relationships among pain, QoL, and psychosocial factors in patients who underwent peripheral nerve surgery. Patients completed questionnaires rating pain; impact of pain on QoL, sadness, depression, frustration, anger, and hopefulness before surgery; and each postoperative follow-up visit. Multilevel modeling was used to assess the concurrent and lagged relationships between pain and psychosocial factors. Results: Increased pain was concurrently associated with decreased hopefulness (P =.001) and increased the impact on QoL, sadness, depression, and anger (P <.001). In lagged analyses, the impact on QoL and anger prospectively predicted pain (P <.001 and P =.02, respectively). Pain predicted subsequent scores of QoL, sadness, depression, anger, and hopefulness (P <.01). Having an upper limb nerve injury and self-report of "no comment for childhood trauma" were predictors of postsurgical pain. Conclusion: Psychosocial measures and pain are reciprocally related among patients who underwent surgery for peripheral nerve injuries or compression. Our study provides evidence of the important relationships among psychosocial factors, pain, and outcome and identifies treatment targets following nerve surgery. [ABSTRACT FROM AUTHOR]

Background: To better understand the occurrence and operative treatment of peripheral nerve injury (PNI) and the potential need for additional resources, it is essential to define the frequency and distribution of peripheral nerve procedures being performed. The objective of this study was to evaluate Ontario's wait times for delayed surgical treatment of traumatic PNI.Methods: We retrieved data on wait times for peripheral nerve surgery from the Ontario Ministry of Health and Long-Term Care Wait Time Information System. We reviewed the wait times for delayed surgical treatment of traumatic PNI among adult patients (age ≥ 18 yr) from April 2009 to March 2018. Data collected included total cases, mean and median wait times, and demographic characteristics.Results: Over the study period, 7313 delayed traumatic PNI operations were reported, with variability in the case volume distribution across Local Health Integration Networks (LHINs). The highest volume of procedures (2788) was performed in the Toronto Central LHIN, and the lowest volume (< 6) in the Waterloo Wellington and North Simcoe Muskoka LHINs. The population incidence of traumatic PNI requiring surgery was 5.1/10 000. The mean and median wait times from surgical decision to surgical repair were 45 and 27 days, respectively. Both the longest and shortest wait times occurred in LHINs with low case volumes. The provincial target wait time was met in 93% of cases, but women waited significantly longer than men (p < 0.001).Conclusion: The provincial distribution of traumatic PNI surgery was variable, and the highest volumes were in the LHINs with large populations. The provincial wait time strategy for traumatic PNI surgery is effective, but women waited longer than men. Precise reporting from all hospitals is necessary to accurately capture and understand the delivery of care after traumatic PNI. [ABSTRACT FROM AUTHOR]

Background: Nerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community.Methods: Data were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included 'spinal cord injury' and 'SCI' and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for 'nerve', 'transfer', 'nerve transfer', and 'nerve surgery'. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation.Results: The search yielded 99 groups; 35 met the inclusion criteria (average size = 2007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%).Conclusion: Social media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies. [ABSTRACT FROM AUTHOR]

Disability reflects physical impairment and the influence of psychosocial factors. We investigated the relationship between disability and psychosocial factors in patients with upper extremity pathology. Ninety-two patients at a hand clinic were evaluated to assess disability, pain intensity, health status and psychosocial factors (pain catastrophizing, depression). Statistical analyses evaluated the relationships among disability and patient and psychosocial factors. Moderate levels of disability from all types of pathology were reported and associated with pain catastrophizing, pain and depression. Health status Short Form 36 domains were not correlated with disability as determined by Disabilities of the Arm, Shoulder and Hand (DASH) scores. A strong correlation was found between DASH and QuickDASH scores, but the QuickDASH scored significantly higher by 4 points. Pain catastrophizing was the strongest predictor of disability and explained 59% and 63% of variation in disability scores. Independent of pathology, those patients experiencing psychosocial issues, as well as demographic factors (i.e. employment status and age), were more likely to have disability with hand conditions and surgical procedures. We conclude from this study that psychological factors affect patient-reported outcomes. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Scapholunate advanced collapse (SLAC) is the most common pattern of wrist arthritis. Sparse data exist regarding the SLAC wrist pattern of arthritis. This study aimed to document the epidemiology of advanced SLAC in terms of patients' sociodemographics and possible association with trauma. Methods: Sixty-one patients with severe SLAC wrist were included. Baseline sociodemographic characteristics were reviewed. To evaluate the relationship to injury, this group of cases was compared with a control group of 61 patients with first carpometacarpal osteoarthritis (CMC OA). The following data were collected for both groups: age, gender, history of traumatic injury, history of manual labor, duration of symptoms, and dominant hand involvement. Pearson chi-square tests for categorical variables and independent samples t test for continuous variables were performed to determine differences between groups. Results: Patients with SLAC wrist were more likely to be male (80.3% vs 31.1%; p<0.001), have a history of a traumatic injury (69.5% vs 25.9%, P <.001), have longer symptom duration (10.3 ± 13.3 vs 3.5 ± 2.5 years, P =.001), be involved in a manual labor job (49.0% vs 20.0%, P =.002), and be younger (53.1 ± 10.4 vs 58.3 ± 9.8; P =.006) compared with patients with CMC OA. There was no difference in dominant hand involvement (49.2% vs 53.3%; P =.571) between the groups. Conclusions: This study identified the characteristics of patients with advanced SLAC wrist. Compared with a control cohort of CMC OA, patients with SLAC wrist were more likely to be male, have a history of a traumatic injury, and be younger. [ABSTRACT FROM AUTHOR]

Health literacy is the extent to which patients are able to understand and act upon health information. This concept is important for surgeons as their patients have to comprehend the nature, risks and benefits of surgical procedures, adhere to perioperative instructions, and make complex care decisions about interventions. Our review aimed to determine the prevalence of limited health literacy of the surgical patient population. A search of MEDLINE and EMBASE was performed from inception until January 14th 2017 for experimental and observational studies reporting surgical patients' health literacy measurement. Overall pooled proportion of surgical patients with limited health literacy was calculated using a random-effects model and methodologic quality was assessed. A total of 40 studies representing 18,895 surgical patients were included in our quantitative synthesis. Pooled estimate of limited health literacy was 31.7% (95%CI 24.7-39.2%, I2 99.0%). There was low risk of bias among the majority of the 51 studies included in the qualitative synthesis. Statistical heterogeneity could not be fully accounted for by methodologic quality or patient and surgical characteristics. However, some of the heterogeneity was accounted by measurement tool [combined proportions with the REALM and NVS of 35.6 (95%CI 31.5-39.9, I2 73.0%)]. A number of different health literacy measurement tools were used (19 overall). Our review demonstrates a high prevalence of limited health literacy among surgical patients with considerable heterogeneity. Our findings suggest the importance of recognizing and addressing surgical patients with limited health literacy and the need for standardization in measurement tools. [ABSTRACT FROM AUTHOR]

Background: Surgical thoracic outlet syndrome (TOS) management involves decompression of the neurovascular structures by releasing the anterior and/or middle scalene muscles, resection of the first and/or cervical ribs, or a combination. Various surgical approaches (transaxillary, supraclavicular, infraclavicular, and transthoracic) have been used with varying rates of complications. The purpose of this study was to evaluate early postoperative outcomes following surgical decompression for TOS. We hypothesized that first and/or cervical rib resection would be associated with increased 30-day complications and health care utilization. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all TOS cases of brachial plexus surgical decompression in the region of the thoracic inlet from 2005 to 2013. Results: There were 225 patients (68% females; mean age: 36.4 years ± 12.1; 26% body mass index [BMI] ⩾ 30). There were 205 (91%) patients who underwent first and/or cervical rib resection (±scalenectomy), and 20 (9%) underwent rib-sparing scalenectomy. Compared with rib-sparing scalenectomy, rib resection was associated with longer operative time and hospital stays (P < .001). In the 30 days postoperatively, 8 patients developed complications (rib-scalenectomy, n = 7). Only patients with rib resection returned to the operating room (n = 10) or were readmitted (n = 9). Conclusions: Early postoperative complications are infrequent after TOS decompression. Rib resection is associated with longer surgical times and hospital stays. Future studies are needed to assess the association between early and long-term outcomes, surgical procedure, and health care utilization to determine the cost-effectiveness of the various surgical interventions for TOS. [ABSTRACT FROM AUTHOR]

This prospective observational study assessed the prevalence of cold sensitivity in patients with nerve compression using the Cold Intolerance Symptom Severity (CISS) questionnaire. One hundred patients (72 women, 28 men; mean age 59 years) with carpal tunnel syndrome (n = 95) or cubital tunnel syndrome (n = 5) were studied. Fifty-two patients reported symptoms of cold sensitivity with a mean CISS score of 50. Overall, significantly more women (58% vs. 36%) reported cold sensitivity with significantly worse CISS scores than men.Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. Method: We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist. Results: Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function. Conclusions: The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified. [ABSTRACT FROM AUTHOR]

Background: The choice of surgical approach for total hip arthroplasty (THA) remains a contentious issue with regards to clinical outcome optimization and restoring patient function. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis.Methods: Patients undergoing THA for primary osteoarthritis of the hip were assigned to 1 of 3 surgical approaches: anterior, posterior and lateral. Standardized implants were used at the time of surgery. Three-dimensional gait analysis was performed preoperatively and at 6 and 12 weeks postoperatively. At each time point, we compared temporal parameters, kinematics and kinetics.Results: We included 30 patients in our analysis (10 anterior, 10 posterior, and 10 lateral). The groups were similar with respect to age (p = 0.27), body mass index (p = 0.16), and Charlson Comorbidity Index score (p = 0.66). Temporal parameters were similar among the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6 weeks (p = 0.041). Affected leg ipsilateral trunk lean during stance was higher in the lateral group than in the other cohorts at 6 weeks (p = 0.008) and 12 weeks (p = 0.040). The anterior and posterior groups showed increased external rotation at 6 weeks (p = 0.003) and 12 weeks (p = 0.012) compared with the lateral group.Conclusion: Temporal gait parameters were similar following THA for all approaches. Differences in gait kinematics and kinetics exist; however, given the small absolute differences, the clinical importance of these changes remains undetermined. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the relationship between reported cold sensitivity, pain, and impact on quality of life (QoL) after upper extremity nerve injury. Methods: This cross-sectional study included adults more than 6 months after an upper extremity nerve injury. Assessment included the Pain Evaluation Questionnaire (pain descriptors, questionnaire, pain intensity, impact on QoL), and Cold Intolerance Severity Scale (CISS). Statistical analyses evaluated the relationships between the Pain Evaluation Questionnaire, CISS, and independent variables. Results: There were 70 patients (mean age 42 ± 16 years). There were high levels of pain, cold sensitivity, and impact on QoL reported. Patients selecting the adjective "coldness" had significantly higher CISS scores (P = .005), pain intensity (P= .008), and impact on QoL (P < .006). Impact on QoL and CISS (r = .35) were moderately correlated. There were significant correlations (P < .01) between the level of cold-induced pain and CISS (r = .78), overall pain intensity (r = .58), pain descriptor score (r = .49), and impact on QoL (r = .32). Conclusions: Cold-induced pain is associated with higher cold sensitivity scores and greater impact on QoL. Reporting a single descriptor "coldness" and ranking cold-induced symptoms were strongly associated with higher cold sensitivity scores and impact on health-related QoL. This may have important implications for quick screening to identify patients with cold sensitivity, and future studies in larger patient samples are necessary to provide additional evidence. [ABSTRACT FROM AUTHOR]

Following upper extremity nerve and tendon reconstruction, rehabilitation is necessary to achieve optimal function and outcome. In this review, the authors present current evidence and literature regarding the strategies and techniques of rehabilitation following peripheral nerve and tendon reconstruction. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the biomedical and psychosocial factors associated with disability at a minimum of six months following upper-extremity nerve injury. Methods: This cross-sectional study included patients who were assessed between six months and fifteen years following an upper-extremity nerve injury. Assessment measures included patient self-report questionnaires (the Disabilities of the Arm, Shoulder and Hand Questionnaire [DASH]; pain questionnaires; and general health and mental health questionnaires). DASH scores were compared by using unpaired t tests (sex, Workers' Compensation/litigation, affected limb, marital status, education, and geographic location), analysis of variance (nerve injured, work status, and income), or correlations (age and time since injury). Multivariable linear regression analysis was used to evaluate the predictors of the DASH scores. Results: The sample included 158 patients with a mean age (and standard deviation) of 41 ± 16 years. The median time from injury was fourteen months (range, six to 167 months). The DASH scores were significantly higher for patients receiving Workers' Compensation or involved in litigation (p = 0.02), had a brachial plexus injury (p = 0.001), or were unemployed (p < 0.001). There was a significant positive correlation between the DASH scores and pain intensity (r = 0.51, p <0.001). In the multivariable regression analysis of the predictors of the DASH scores, the following predictors explained 52.7% of the variance in the final model: pain intensity (Beta = 0.230, p= 0.006), brachial plexus injury (Beta = -0.220, p = 0.000), time since injury (Beta = -0.198, p = 0.002), pain catastrophizing score (Beta = 0.192, p = 0.025), age (Beta = 0.187, p = 0.002), work status (Beta = p.179, p = 0.008), cold sensitivity (Beta = 0.171, p = 0.015), depression score (Beta = 0.133, p = 0.066), Workers' Compensation/litigation (Beta = 0.116, p = 0.049), and female sex (Beta = -0.104, p = 0.090). Conclusions: Patients with a peripheral nerve injury report substantial disability, pain, and cold sensitivity. Disability as measured with the DASH was predicted by brachial plexus injury, older age, pain intensity, work status, time since injury, cold sensitivity, and pain catastrophizing. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of Levels of Evidence. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upper-extremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients. Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury. Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning. [ABSTRACT FROM AUTHOR]

Background Successful free flap surgery in the head and neck is dependent on the successful anastomosis of both artery and vein. The success of all free flaps was analyzed to determine the necessity for performing 2 venous anastomoses. Methods We retrospectively analyzed a single surgeon's 10-year experience (August 1993–August 2003) in free flap reconstruction for malignant tumors of the head and neck. Four hundred ninety-two free flaps were primary reconstructions that did not require a vein graft, vein loop, or cephalic turnover procedure. Three hundred forty-five flaps had 1 venous anastomosis, and 147 flaps had 2 venous anastomoses. Results Overall, flap success was 468 of 492 (95.1%). Successful flap reconstruction in patients undergoing 2 venous anastomoses was 145 of 147 (98.6%) compared with 323 of 345 (93.6%) in patients undergoing 1 anastomosis (p < .05). Conclusion Where possible, a second venous anastomosis should be performed in head and neck free flap reconstruction. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]

Background. Few reports have compared reconstructive outcomes of primary versus secondary mandibular reconstruction. Methods. A retrospective chart review was performed on 149 patients following primary (n = 110) and secondary reconstruction (n = 39). Results. There was no statistically significant difference in patient demographics between the 2 groups. The secondary reconstruction mandibular defects were more extensive; significantly more involved the condyle or the central portion of the mandible. The vascularized fibular flap was most commonly used (primary 82%, secondary 69%). The overall complication rate was similar in both groups. There was no statistical difference in the frequency of complications between the primary or secondary reconstruction groups (acute, p = .40; late, p = .17). Conclusions. Success in secondary mandibular reconstruction could be achieved utilizing a range of osseous free flaps, and there was no increased rate of complications compared with primary mandibular reconstructions. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]

Background. This study reports our experience with fasciocutaneous reconstruction of circumferential pharyngoesophageal defects using an anterolateral thigh flap wrapped around a salivary bypass tube. Methods. The charts of 14 patients were reviewed. All patients who had reconstruction of a pharyngoesophageal defect using an anterolateral thigh flap with a salivary bypass tube between 2001 and 2005 were included. Results. There were 10 men and 4 women (mean age, 61 years). There were no fistulae reported, and the stricture rate was 14%. Eleven patients achieved oral diet sufficient to have the gastrostomy or jejunal tube removed. The patients who had tracheoesophageal puncture for voice developed functional speech. There were no flap losses. However, problems with salivary tube migration in the early cases have led to technique refinement. Conclusions. The low complication rates and the excellent functional outcomes make the anterolateral thigh flap in combination with a salivary bypass tube a viable option for reconstruction of these difficult defects. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [ABSTRACT FROM AUTHOR]

Objective: This study assessed patient outcome following surgical reconstruction of the accessory nerve after an iatrogenic injury. Study Design: A retrospective chart review of 8 patients was performed. Results: There were 3 men and 5 women in the study, and the mean time between injury and nerve graft/repair surgery was 5 months. Four injuries were sustained during a lymph node biopsy. Electromyography revealed a complete accessory nerve injury in all cases. In 6 cases, a nerve graft was required (mean length, 3.6 cm), and in 2 cases, a direct nerve repair was possible. The trapezius muscle was successfully reinnervated in all cases. In total, full shoulder abduction was achieved in 6 cases; in the remaining 2 cases, the patients achieved shoulder abduction to 90°. Conclusion: Functional deficit after accessory nerve injury is significant. Nerve graft/repair reconstruction reliably yields a satisfactory result, providing good scapular rotation and thus good shoulder function. (Otolaryngol Head Neck Surg 2002;127:221-24.) [Copyright &y& Elsevier]