Browsing by Author "Hudson, Donald"
Now showing 1 - 10 of 10
Results Per Page
Sort Options
- ItemOpen AccessAnthropometric Changes in a Prospective Study of 100 Patents Requesting Breast Reduction(2020) Lelala, Ngoato Bruce; Hudson, DonaldBackground The anthropomometry of the “ideal” breast is well described, but changes that occur with enlarged breasts are not. The aim of this study was to assess the prevalence of nipple asymmetry in the horizontal plane and changes in the inframammary fold (IMF) in patients presenting with macromastia (defined as excessive development of the mammary gland by Merriam-Webster dictionary). Methods One hundred patients (200 breasts) presenting to the Plastic Surgery Clinic for bilateral breast reduction were enrolled in this study. Patient's characteristics captured for this study included age, body mass index (BMI), and breast anthropometric measurements, such as suprasternal notch to nipple, nipple to IMF, IMF projected to cubital fossa, midhumeral point, and nipple measurement from meridian. Basic univariate statistical analysis were performed to evaluate the impact of nipple asymmetry. Results The average age was 37 years (SD 12 years), and the median BMI was 33 (IQR 28-37). More patients presented with nipple asymmetry, of whom 45% were classified as lateral to meridian, 19% were classified as medial to the meridian, and 36% were classified as central to the meridian. Patients with lateral asymmetry and medial asymmetry has a significantly higher BMI (median BMI 35) compared with patients with central positioning (median 30). Increasing breast size was positively associated with nipple asymmetry, whereas BMI (R = - 0.30, P =0.003) and macromastia correlated negatively with IMF position (R= - 0.38), P= 0.0001). Conclusion In macromastia, nipple displacement from breast meridian, especially lateral displacement, is common and is aggravated by an increase in BMI. The IMF also descends, and this is also common in patients with a raised BMI. These changes have clinical implications.
- ItemOpen AccessArterial microanastomosis with size mismatch : a trial of two techniques(2010) Rickard, Rory Frederick; Hudson, DonaldUse of perforators as recipient vessels in microvascular reconstruction has led to arterial diameter discrepancy becoming an increasingly common finding. Experimental and clinical evidence confirms that patency rates decrease with increasing diameter mismatch, but no good evidence is available to direct the choice of end-to-end microanastomotic technique where a small-to-large discrepancy exists. A programme of research has been conducted comparing two techniques of endto-end arterial microanastomoses, where a small-to-large diameter discrepancy exists of between 1:1.5 and 1:2.5. These techniques are; 45º oblique section of the smaller vessel, and; invaginating the smaller vessel inside the larger.
- ItemOpen AccessThe biomechanics of negative-pressure wound therapy(2011) Kairinos, Nicolas; Hudson, DonaldDespite the success of negative-pressure wound therapy, its mechanism of action remains unclear. The common perception that it reduces tissue pressure and increases perfusion has recently been challenged following the observation that tissue necrosis can be caused as a result of its application. A programme of research has been conducted to clarify how tissue pressure changes during negative-pressure wound therapy and the resultant effect thereof on perfusion. The cause for conflicting evidence from other studies was also investigated.
- ItemOpen AccessEvaluation of the clinical outcome of curvilinear transport distraction osteogenesis and revascularised fibula free flaps in the reconstruction of large post-maxillectomy defects(2017) Hendricks, Mogamat Rushdi; Vicatos, George; Hudson, DonaldBackground: Maxillary defects caused by trauma or tumour resection in the head and neck region can be devastating to the patient from a cosmetic and functional perspective. Patients who undergo maxillectomy procedures experience a substantial deterioration in their primary oral functions such as breathing, mastication, salivation, deglutition and phonation, which has a collective adverse influence on their quality of life (QOL). The revascularised free fibula flap (RFFF) has been demonstrated to be most reliable for the reconstruction of maxillary defects, and has been regarded as the 'gold standard.' A novel method of regenerating bone and soft tissue through the process of curvilinear transport distraction oseteogenesis (CTDO) has been developed and compared with the RFFF technique. Method: A prospective cohort study of 6 post-maxillectomy patients was compared regarding the clinical outcome of function and aesthetics with a group of 6 patients who had undergone RFFF reconstruction. The new bone (regenerate) was compared with the parent bone from which it had been generated. Objective measuring tools were employed to assess pre and post quality of life (QOL) aspects. The RFFF patients were not subjected to any invasive procedures save to undergo a clinical evaluation and undergo a CT scan of their maxillae. A cohort of 6 participants was treated prospectively using CTDO and the results were analysed within that cohort. These results were compared with a retrospective group of 6 participants of similar age and gender distribution who had undergone RFFF reconstruction as an external control. The patented Hendricks-Vicatos (H-V) maxillary transport distractor was applied to all selected participants by the primary investigator under general anaesthesia at Groote Schuur Hospital or a private clinic. The H-V maxillary transport distractor (5 prototypes) was pre-shaped and pre-fitted onto a 3-D model of the participant's maxilla, in a laboratory. This method reduced clinical installation time. If teeth were present in the area to be distracted, then at least 2 teeth were removed from the maxilla, preferably three months before the date of distraction. In the first few cases, this was the protocol for developing bone stock. This protocol was revised in the last 2 patients of the study, where no teeth were extracted at all. A linear fracture (bi-cortical) was created in the maxilla in a vertical direction (segmentally) to develop a mobile, well-vascularised transport disc. This carrier disc was attached to the metal plate of the 'crawler' via small titanium screws. The crawler was then moved on the reconstruction plate (BiometTM Zimmer Biomet,
- ItemOpen AccessMicrovascular free tissue transfer for the head and neck reconstructive in a resource-limited setting(2016) Dos Passos, Gary; Hudson, DonaldBackground: Free tissue transfer has become the standard of care for the reconstruction of head and neck oncological defects. The Groote Schuur Hospital provides a microsurgical reconstructive service in a resource-limited setting, without access to venous couplers, invasive monitoring devices, modern microscopes or sophisticated pre-operative imaging. The reconstructive surgeons perform all anastomoses under x4.5 loupe magnification. Methods: A retrospective chart review was undertaken of cases performed by the service over a 3-year period. Demographic factors, indications for flap cover, operative details (flap used, duration and lowest recorded temperature), intensive care and hospital length of stay, and other outcomes were recorded and evaluated (including flap and systemic complications, donor site morbidity, haematomas as well as returns to theatre). Results: Over a 36-month period, 109 flaps for head and neck reconstruction were performed. The main indication for surgery was squamous cell carcinoma of the oral cavity. The mean operating time for resection and reconstruction was 6.02 h (range of 4 to 12 h). Virtually, all reconstructions were performed using one of either radial forearm, free fibula or anterolateral thigh flaps. We report a complete flap loss rate of 6 %. All four successful salvages were undertaken in the early (less than 24 h) post-operative period. Hypothermia intra-operatively appears to correlate very closely with pejorative outcomes. Conclusions: By restricting reconstructive options to three main 'workhorse' flaps and by utilising a simultaneous two-team approach for tumour ablation and flap elevation, success rates comparable to international standards have been achieved. Limited resources should not be regarded as an impassable barrier to providing a successful microvascular head and neck reconstructive service.
- ItemOpen AccessNegative pressure wound therapy management of the "open abdomen" following trauma: a prospective study and systematic review(BioMed Central Ltd, 2013) Navsaria, Pradeep; Nicol, Andrew; Hudson, Donald; Cockwill, John; Smith, JenniferINTRODUCTION: The use of Negative Pressure Wound Therapy (NPWT) for temporary abdominal closure of open abdomen (OA) wounds is widely accepted. Published outcomes vary according to the specific nature and the aetiology that resulted in an OA. The aim of this study was to evaluate the effectiveness of a new NPWT system specifically used OA resulting from abdominal trauma. METHODS: A prospective study on trauma patients requiring temporary abdominal closure (TAC) with grade 1or 2 OA was carried out. All patients were treated with NPWT (RENASYS AB Smith & Nephew) to achieve TAC. The primary outcome measure was time taken to achieve fascial closure and secondary outcomes were complications and mortality. RESULTS: A total of 20 patients were included. Thirteen patients (65%) achieved fascial closure following a median treatment period of 3 days. Four patients (20%) died of causes unrelated to NPWT. Complications included fistula formation in one patient (5%) with spontaneous resolution during NPWT), bowel necrosis in a single patient (5%) and three cases of infection (15%). No fistulae were present at the end of NPWT. CONCLUSION: This new NPWT kit is safe and effective and results in a high rate of fascial closure and low complication rates in the severely injured trauma patient.
- ItemOpen AccessPatient reported outcome measures (PROMs) in breast cancer patients after immediate breast reconstruction using the Breast-Q(2020) Möller, Ernst Lodewicus; Cairncross, Lydia; Panieri, Eugenio; Hudson, DonaldBackground Mastectomy is the mainstay of surgical treatment for women with breast cancer in South Africa. The increase in breast reconstruction after a mastectomy has prompted the need to evaluate patient reported outcome measures (PROMs) for this set of operative intervention. This study aimed to assess clinical and patient reported outcome measures in immediate breast reconstruction patients using the BREAST-Q and compare these with international cohorts. Methods A cross-sectional study was performed on all patients who underwent immediate breast reconstruction between January 2011 and December 2016. This consisted of a retrospective clinical record review of perioperative outcomes, and a quality of life analysis using the BREAST-Q Post-Reconstruction questionnaire. Outcome predictors were identified using Chi-square, Fisher exact, One-way ANOVA, Student t-tests and Kruskal Wallis analysis of variance. A random-effect single arm meta-analysis was performed to compare the BREASTQ scores with international cohorts. Results A total of 52 patients were included with a mean age of 43.2 (+/-9.5) years. Eighteen patients (34.6%) developed early complications; of these 8 (44.4%) were major. Thirty-one patients (59.6%) developed late complications; of these 18 (58.1%) were major. Fifteen patients (28.8%) had failed reconstruction. There was a significantly higher risk of failure following a total mastectomy (TM) (p=0.02), tissue expander reconstruction (TE) (p< 0.01) and stage 2 breast cancer (p=0.01). Patients who underwent nipple reconstruction and immediate-delayed reconstruction before 12 months, reported higher well-being and satisfaction scores. Compared to international cohorts our BREAST-Q scores were lower but fall within the 95% confidence interval for Sexual Well-Being and Satisfaction with Nipples and Care. Conclusion Immediate breast reconstruction poses a high risk of complications and reconstructive failure especially, with TM and TE. Our BREAST-Q scores are comparable to international studies and may be useful in guiding patient consent.
- ItemOpen AccessPercutaneous Puncture of Flexor Sheath Ganglions: An Assessment of Recurrence(2020) Najjaar, Azzaam; Hudson, Donald; Solomons, Michael; McGuire, DuncanBackground Flexor tendon sheath ganglions (FTSG) comprise up to 15% of hand ganglions. The management is split between two schools of practice: percutaneous puncture or surgical excision. The literature is equivocal as to which holds true superiority in terms of recurrence rates. The cost of surgical excision is higher and the recovery is longer. In addition, surgery also brings with it the potential for surgical complications, both immediate and long term. Percutaneous puncture can be performed at the time of the initial consult and an immediate return to normal activity with no down-time for the patient. The aim of this study is to assess the recurrence rate after percutaneous puncture. We also describe our employed technique. Method The technique for percutaneous puncture involved the use of a 25-gauge needle for ganglion puncture, no sclerosant or corticosteroid was injected, and an immediate post-procedure mobilisation protocol was employed. Patients were identified from clinical records and were followed up at a minimum of six months to check for recurrence. Results Eighteen patients were included in the study, 12 females and 6 males. The majority of FTSG were found to occur in the middle finger. Two patients experienced a recurrence. Both were successfully treated with a repeat puncture. No patients experienced a complication. Conclusion In our study, we show a low recurrence rate obtained with percutaneous puncture of FTSG using a simple technique. No complications were noted in our cohort on follow-up. We, therefore, recommend employing it as a first line treatment in the management of FTSG.
- ItemOpen AccessThe role of propranolol in the treatment of infantile haemangioma(2013) Moodley, Sean Thirumalay; Hudson, DonaldThere has been a change in the management of infantile haemangioma with the introduction of propranolol. The aim of this study is to retrospectively evaluate a simple treatment for infantile haemangioma at the Red Cross War Memorial Children’s Hospital (RCWMCH) and document the results. While it is known that all haemangiomas undergo involution at some stage, some haemangiomas pose certain problems. These relate mainly to visual axis obstruction and aesthetics. Subjects are children in the first two years of life presenting with haemangiomas. All patients were treated with oral propranolol in conjunction with haemangioma size documentation, using a simple radiological modality, i.e. ultrasound imaging. Patients are followed up and clinical and radiological evaluations are undertaken to observe changes in size and appearance. Propranolol is non-selective β-adrenergic antagonist that is used extensively for the treatment of a multitude of disorders, mainly cardiovascular indications. The main adverse effects include bradycardia, hypotension and bronchospasms. For the purposes of this study, all subjects were routinely examined, especially with regard to the cardiopulmonary systems. Any perceived anomaly was referred to the cardiorespiratory physicians at RCWMCH for further evaluation, which includes all the necessary investigations such as electrocardiograms(ECG) and echocardiograms. Therefore, only fit healthy patients were selected for this study. Patients are educated and fully informed regarding the adverse effect profile of propranolol, and advised of the appropriate route of management.
- ItemOpen AccessVentilator associated pneumonia in major paediatric burns(2013) Rogers, Alan David; Rode, Heinz; Hudson, DonaldIncludes abstract. Includes bibliographical references.