Background: Lymphovenous anastomosis is technically challenging and can be successfully performed with an advanced operating microscope, supermicrosurgical instruments, and indocyanine green lymphography. This study compared the outcomes between side-to-end and end-to-end lymphovenous anastomosis configurations for unilateral extremity lymphedema. Methods: Between April of 2013 and June of 2017, lymphovenous anastomosis was indicated for 58 patients who preoperatively had patent lymphatic ducts by indocyanine green lymphography, including 20 patients with upper limb lymphedema and 38 patients with lower limb lymphedema. Either an end-to-end or a side-to-end lymphovenous anastomosis was used to anastomose the subdermal venule to the lymphatic duct. The circumferential difference and episodes of cellulitis were used as outcome measurements. Results: Twenty-three patients underwent an end-to-end lymphovenous anastomosis and 35 patients underwent side-to-end lymphovenous anastomosis. All patients had an immediate patency evaluated by indocyanine green lymphography and patent blue assessments. All patients returned to their daily routine without the use of any compression garments. At an average follow-up of 16.5 months (range, 13.4 to 19.6 months), the improvement of circumferential difference (3.2 percent; range, 1.8 to 4.6 percent) in the side-to-end group was statistically greater than that in the end-to-end group (2.2 percent; range, 1 to 3.4 percent; p = 0.04). The overall episodes of cellulitis were significantly reduced from 1.7 times/year (range, 1.3 to 2.1 times/year) to 0.7 times/year (range, 0.3 to 1.1 times/year; p < 0.001), but no difference was observed between the two groups. Conclusions: Both side-to-end and end-to-end lymphovenous anastomosis configurations were effective surgical approaches for improving early-grade extremity lymphedema. Side-to-end lymphovenous anastomosis has the advantages of having greater efficacy for lymph drainage, requiring only one anastomosis and eliminating the need to use compression garments. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Background: The use of autologous grafts is a standard reconstructive option in plastic surgery. The absence of a well-established protocol for decontamination after accidental contamination increases the risk of postoperative infection. We aimed to explore the current practice and decontamination methods among Saudi plastic surgeons. This would help develop a well-established, unified method of decontamination intraoperatively. Methods: A validated self-administered questionnaire cross-sectional study was conducted in February 2022. The questionnaire was distributed through social media to all board-certified plastic surgeons in Saudi Arabia. The questionnaire was designed to obtain data on incidents, treatment preferences, and management of autograft contamination. Results: A total sample size of 61 participants was included, with an overall response rate of 64.58%. Out of the 61 respondents, 73.8% (n = 45) had previously experienced graft contamination. Regarding the methods of graft contamination, the most common way was accidentally dropping the graft on the floor (39.7%, n = 25). The majority of the surgeons answered that they decontaminated the graft using povidone-iodine (44.6%, n = 29) and then used it (45.9%, n = 28). The lower extremity area was the most common anatomical location having surgery at the time of the graft contamination, accounting for 32.5% of the cases (n = 25). Conclusions: Our study indicates that graft contamination is a common occurrence among our population, but we lack national guidelines on dealing with these situations. Although most responders used adequate decontamination methods, the lack of standardization could pose a risk to patients.
Background: The future career choices of medical students are influenced by the medical school curriculum and exposure they receive in the schools. A thorough understanding of the students’ knowledge and perception about a specialty like plastic surgery is essential for assessing the scope and career choices. This study evaluates the medical students’ knowledge and perception of plastic surgery in the western region of Saudi Arabia. Methods: This is a cross-sectional online survey study that was conducted using a pre-tested questionnaire which was distributed between senior medical students. The questionnaire recorded participants’ sociodemographic details, their knowledge about the specialty of plastic surgery, and their perception of the specialty. The data collected were subjected to Statistical analysis using SPSS Ver.23 and a p-value of < 0.05 was deemed significant. Results: The majority of the students (78.3%) reported poor knowledge regarding plastic surgery while 11% of the respondents had previously taken a clinical rotation in plastic surgery department. Female medical students had comparatively demonstrated better knowledge than male students regarding the specialty (p<0.034). It was reported by 43.2% of students that plastic surgery is the same as other specialties, whereas 53.2% believed that this specialty is an essential one. Only 34.1% of the students were interested in pursuing plastic surgery as a specialty after graduation. Conclusion: The study finding highlights that the knowledge about plastic surgery is not satisfactory among medical students. There is a need to improve knowledge about this specialty. The medical curriculum should fill the voids and give more considerations for this specialty when training undergraduate medical students, which would positively influence their career choices.
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