Browsing by Author "Hudson, Donald Anthony"

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    Autologus fat grafting for mild to moderate velopharyngeal insufficiency: Our experience
    (2018) Xoagus, Elizabeth Alexia; Adams, Saleigh; Hudson, Donald Anthony
    The standard surgical treatment of velopharyngeal insufficiency (VPI) includes revision palatoplasty, posterior pharyngeal flap and sphincter pharyngoplasty. These procedures are not without complication and can also be challenging to the occasional cleft surgeon. The greatest complication is iatrogenic obstructive sleep apnoea particularly in high risk patients. With the introduction of posterior pharyngeal wall augmentation, a lesser and simpler surgical procedure, various materials have been used for this purpose with limited success and significant complication rates. Augmentation of the velo-pharynx with autologous fat has been practiced for decades. Autologous fat has multiple advantages compared to other biological and synthetic materials used for augmentation of the velopharynx. Autologous fat is readily available, has low donor site morbidity, does not migrate, injects easily and is non-allergenic. The outcome of fat grafting for VPI is good and stable long term, albeit unpredictable due to the resorption of fat. The procedure may therefore need to be repeated in order to achieve the desired results. The aim of this study is to evaluate and document the outcome of autologous fat grating for the treatment of mild to moderate VPI in children at the Red Cross War Memorial Children's Hospital (RCWMCH). A retrospective folder review was conducted on 9 consecutive patients who underwent velopharygeal fat grating for the treatment of mild to moderate VPI at the RCWMCH from 2010 to 2014. All the patients had had primary palatoplasty performed previously and subsequently developed VPI. Patients were assessed pre- and postoperatively by two cleft surgeons, and an experienced speech and language therapist with the aid of laterl view videofluoroscopy (VF). Pre-operative and post-operative perceptual speech assessments were performed by a dedicated speech and language therapist. Two senior cleft surgeons performed pre-and post-operative videofluoroscopy interpretations. Eleven fat grafting procedures were performed on 9 patients and an average of 5.64 ml (range 1 ml to 7 ml) of autologous fat was transferred to the velopharynx. The average age at the time of operation was 6.5 years (range 3 years to 14 years) with a follow-up period of 18 months (range 7 months to 34 months). Most of the patients (7 out of 9) showed improved speech following fat grafting. There were no complications related to the fat grafting procedure. This small study suggests that fat grafting is an effective, minimally invasive surgical alternative for the treatment of mild to moderate VPI and to our knowledge, is the first reported study from Africa.
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    The use of Acellular Dermal Matrices in the Management of Complex Traumatic Wounds in a Paediatric Population
    (2020) Pillay, Kamlen; Adams, Saleigh; Hudson, Donald Anthony
    Introduction Complex soft tissue injuries are common in children. Paediatric wounds associated with large soft tissue defects pose a surgical challenge. This often necessitates extensive reconstructive surgery and frequently requires the use of microvascular free flaps. Local, regional and free flap surgery in children poses several challenges related to donor site morbidity, flap failure and the long-term sequelae of repeated surgeries for flap modification in a growing child. The introduction of acellular dermal matrices (ADM's) in recent decades has dramatically influenced the management of complex soft tissue wounds. The dermis in skin represents the functional aspect of skin. ADM's represent dermal structures artificially, hence their incorporation into the wound should restore skin characteristics specifically pliability. Some authors believe that ADM's have improved prognosis and reduced morbidity in the treatment of open wounds. Combining the use of ADM's together with split-thickness skin grafting (SSG) is rapidly becoming an important method used to manage such complex wounds. In this study, we explore whether the use of this technique has been a beneficial addition to the traditional management armamentarium for complex injuries in the extremities and report the rate of complications experienced by our patients at our paediatric hospital in Cape Town. Objective This study reviewed the number of complications experienced with the use of ADM's in treating complex wounds on the extremities of children. It includes 54 children treated between the years 2011 and 2016 at a national paediatric hospital. Methodology A retrospective folder review of children treated at our hospital between the years 2011 and 2016 with extremity injuries was conducted. A total of 189 patient folders were reviewed. Children (n= 54) with complex wounds in their extremities who had received an ADM were included in this study. Both short and long-term complications were identified. The patient age range was six months - 12 years, while the mean patient follow-up period was 390 days. Results All patients treated with ADMs for traumatic extremity injuries during this period were included in the study, irrespective of age or co-morbidities. In 45 patients the ADM and SSG healed without any complication that is, not requiring revision surgery at 1 year follow up. Seven patients who did not receive postoperative splinting and occupational / physiotherapy displayed wound contractures, requiring further reconstructive surgery, 4 of which were also in the group who experienced complete ADM or graft loss below. Six patients experienced complete loss of the ADM due to infection, which led to graft failure, requiring revision surgery. Of the six patients that experienced complete loss of the ADM, five were not treated with NPWT dressings. Noteworthy, is that all 45 patients who healed without any complication were treated with NPWT dressings. Biopsies that were performed on 18 patients at 2 weeks post application of the ADM, showed only granulation tissue. No evidence of residual ADM or accessory dermal structures was found in any of the samples, which were obtained from multiple loci of the ADM in situ. The mean time to closure with this method was 3 weeks and the mean hospital stay was 26 days. Two patients were lost to follow-up and were excluded from the morbidity analysis arm of the study. Discussion We found that post-operative physiotherapy, occupational therapy and splinting are extremely important in preventing morbidity in particular scar contracture when associated with wounds treated with ADMs. There was no histological evidence to suggest that the ADM remains intact after 2 weeks post application. Our data reveals that vacuum assisted closure is a vital adjunct to this method, ensuring adequate ADM and graft take. Conclusion Complex wounds in the extremities of children pose a reconstructive dilemma to the plastic surgeon. In anatomically sensitive areas where traditional plastic surgery options are unavailable or undesirable, the use of ADMs and SSGs represent a realistic alternative for the reconstruction of large wounds associated with complex soft tissue injuries in the extremities of children.