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  1. Article ; Online: Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial.

    Kwasnicki, Richard Mark / Giannas, Emmanuel / Rizk, Chiara / Kungwengwe, Garikai / Dutta, Tanusree / Dunne, Jonathan / Dex, Elizabeth / Gokani, Vimal / Henry, Francis P / Hunter, Judith E / Williams, Georgina / Abela, Chris / Warren, Oliver / Jones, Rowan Pritchard / Wood, Simon H

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2024  Volume 93, Page(s) 281–289

    Abstract: Purpose: This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- ... ...

    Abstract Purpose: This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA).
    Methods: A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours.
    Results: A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046).
    Conclusion: This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.
    Language English
    Publishing date 2024-04-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2024.04.048
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  2. Article ; Online: Identifying variation in the cost of abdominally based breast reconstruction in the UK.

    Kwasnicki, Richard M / Irukulla, Meghna / Che Bakri, Nur Amalina / Whiteman, Elena / Gardiner, Matthew / Dunne, Jonathan / Henry, Francis P / Gokani, Vimal / Hunter, Judith E / Williams, Georgina / Wood, Simon H

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2023  Volume 88, Page(s) 466–472

    Abstract: Aims: To understand variation in the cost of autologous breast reconstruction in the UK, including identifying key areas of cost variability, differences between and within units and the impact of enhanced recovery protocols (ERAS).: Methods: A micro- ...

    Abstract Aims: To understand variation in the cost of autologous breast reconstruction in the UK, including identifying key areas of cost variability, differences between and within units and the impact of enhanced recovery protocols (ERAS).
    Methods: A micro-costing study was designed based on the responses to a national survey of clinical preferences completed by the majority of plastic surgeons and anaesthetists involved in the UK. Detailed costs were estimated from macro elements such as ward and theatre running costs, down to that of surgical meshes, anaesthetic drugs and flap monitoring devices.
    Results: The largest variation in cost arose from postoperative location and length of stay, preoperative imaging and flap monitoring strategies. Plastic surgeon costs varied from £1282 to £3141, whereas anaesthetic costs were between £32 and £151 (not including salary). Estimated cost variation within units was up to £893 per case. Units with ERAS had significantly lower total costs than those without (p < 0.05).
    Conclusion: This study reveals significant cost variation in breast reconstruction in the UK based on clinician preferences. Many areas of practice driving this variation lack strong evidence of any clinical advantage. The total cost of a deep inferior epigastric perforator in the majority, if not all units, likely surpasses the national tariff for reimbursement, particularly when considering additional resource demand for immediate and bilateral breast reconstruction, as well as future symmetrisation procedures. Whilst units should look to streamline costs through ERAS, there should also be a realistic tariff that promotes excellent care.
    MeSH term(s) Humans ; Female ; Mammaplasty/methods ; Surgical Flaps/surgery ; United Kingdom ; Perforator Flap/surgery ; Breast Neoplasms/surgery ; Epigastric Arteries/surgery ; Retrospective Studies
    Language English
    Publishing date 2023-11-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2023.11.025
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  3. Article ; Online: Preserving a patent DIEP pedicle to facilitate salvage breast reconstruction with a second free flap: A case report.

    Reissis, Dimitris / Butler, Daniel P / Henry, Francis P / Wood, Simon H

    Microsurgery

    2018  Volume 38, Issue 5, Page(s) 563–566

    Abstract: Surgeons performing free flap breast reconstruction need to have a range of techniques in their armamentarium to successfully salvage cases of flap failure. We present a case of 47-year-old patient who suffered near-total right breast deep inferior ... ...

    Abstract Surgeons performing free flap breast reconstruction need to have a range of techniques in their armamentarium to successfully salvage cases of flap failure. We present a case of 47-year-old patient who suffered near-total right breast deep inferior epigastric perforator (DIEP) flap failure 3 days post-bilateral immediate breast reconstruction with DIEP flaps. At debridement, the DIEP pedicle was noted to be patent with preserved perfusion to a small segment of tissue around the origin of the pedicle. This tissue and the DIEP pedicle itself were therefore preserved to facilitate subsequent breast reconstruction using stacked transverse upper gracilis flaps anastomosed end-to-end to the original DIEP pedicle. Post-operatively, both flaps remained viable with no further complications and symmetrical aesthetic result maintained at 2 months follow-up post-salvage procedure. This case emphasizes the importance of exercising caution during initial debridement for free flap failure to preserve viable tissue in the flap and pedicle, particularly in circumstances where vascular flow in the pedicle is maintained, to facilitate successful salvage reconstruction.
    MeSH term(s) Anastomosis, Surgical/methods ; Autografts ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/surgery ; Debridement/adverse effects ; Debridement/methods ; Epigastric Arteries ; Female ; Follow-Up Studies ; Free Tissue Flaps/surgery ; Gracilis Muscle/surgery ; Graft Survival ; Humans ; Mammaplasty/methods ; Mastectomy/rehabilitation ; Middle Aged ; Perforator Flap/adverse effects ; Perforator Flap/blood supply ; Physical Appearance, Body ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Treatment Outcome
    Language English
    Publishing date 2018-01-08
    Publishing country United States
    Document type Case Reports
    ZDB-ID 605524-2
    ISSN 1098-2752 ; 0738-1085
    ISSN (online) 1098-2752
    ISSN 0738-1085
    DOI 10.1002/micr.30292
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  4. Article ; Online: Secondary free tissue transfer in head and neck reconstruction.

    Vamadeva, Sarita V / Henry, Francis P / Mace, Alasdair / Clarke, Peter M / Wood, Simon H / Jallali, Navid

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2019  Volume 72, Issue 7, Page(s) 1129–1134

    Abstract: Background: The incidence of head and neck cancer (H&N) continues to increase together with the need for reconstructive surgery. Head and Neck microsurgeons are likely to encounter challenging secondary free flap surgery on the background of failed ... ...

    Abstract Background: The incidence of head and neck cancer (H&N) continues to increase together with the need for reconstructive surgery. Head and Neck microsurgeons are likely to encounter challenging secondary free flap surgery on the background of failed primary flaps, radiotherapy treatment or recurrence. The aim of this study was to review our experience of treating such cases in a tertiary referral centre in the United Kingdom.
    Methods: We performed a retrospective analysis of all patients undergoing sequential free flap surgery for head and neck defects in our unit during 2010-2017. Parameters recorded included indication for surgery, type and sequence of reconstruction, recipient vessel use and post-operative complications.
    Results: We identified 17 patients who underwent 39 free tissue transfers for the reconstruction of head and neck defects (five transfers were performed at other units). The radial forearm and anterolateral thigh flaps were most commonly used. Almost a quarter of patients underwent three or more free flap reconstructive procedures. In over a third, the same vein and artery were used for subsequent anastomoses, and we used five vein grafts over 68 anastomoses. There were no flap failures recorded.
    Conclusions: Secondary free flaps in the head and neck are required for a variety of aetiologies and can have success rates similar to those for primary free tissue transfers with minimal morbidity and mortality. Free tissue transfer is the best reconstructive option in H&N patients and should still be considered the first choice option in salvage cases until the patient's donor sites have been depleted.
    MeSH term(s) Adult ; Aged ; Carcinoma, Squamous Cell/surgery ; Female ; Free Tissue Flaps/blood supply ; Free Tissue Flaps/transplantation ; Head and Neck Neoplasms/surgery ; Humans ; Male ; Microsurgery/methods ; Middle Aged ; Neuroblastoma/surgery ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Reconstructive Surgical Procedures/methods ; Reoperation/methods ; Retrospective Studies ; Sarcoma/surgery ; Treatment Outcome
    Language English
    Publishing date 2019-03-09
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2019.02.015
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  5. Article ; Online: Predicting and planning for SIEA flap utilisation in breast reconstruction: An algorithm combining pre-operative computed tomography analysis and intra-operative angiosome assessment.

    Henry, Francis P / Butler, Daniel P / Wood, Simon H / Jallali, Navid

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2017  Volume 70, Issue 6, Page(s) 795–800

    Abstract: Background: Low flap complication rates and excellent aesthetic outcomes are now commonplace in breast reconstruction. As a result, attention is now being focussed on minimising donor site morbidity. Despite its potential donor site advantages, the ... ...

    Abstract Background: Low flap complication rates and excellent aesthetic outcomes are now commonplace in breast reconstruction. As a result, attention is now being focussed on minimising donor site morbidity. Despite its potential donor site advantages, the superficial inferior epigastric artery (SIEA) flap is often discounted, given concerns about the high flap failure rates. In this study, we present our experience of using the SIEA flap in breast reconstruction and provide an algorithm based on pre-operative computed tomography angiography (CTA) to aid pre-operative planning.
    Methods: A retrospective analysis of SIEA flap breast reconstruction cases performed at our unit between 2009 and 2016 was performed and outcomes were assessed. In addition, the patients' pre-operative CTA images were assessed and compared to those of a matched group of patients who underwent deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.
    Results: Twenty-six patients who underwent SIEA flap breast reconstruction were eligible for inclusion. No flaps were lost. Donor site seroma rate was 20%. The largest SIEA diameter in those who underwent an SIEA flap was significantly larger (p = 0.0001) than in those who underwent DIEP flap breast reconstruction. Significantly more number of patients who underwent SIEA flap breast reconstruction had a SIEA diameter greater than or equal to that of the largest DIEP flap perforator (p = 0.0001) in the group where a DIEP flap was used for breast reconstruction.
    Conclusion: High success rates can be achieved with abdominal flaps based on the superficial vascular system and careful pre- and perioperative assessment of patients.
    MeSH term(s) Abdomen/diagnostic imaging ; Adolescent ; Adult ; Aged ; Algorithms ; Child ; Child, Preschool ; Computed Tomography Angiography ; Epigastric Arteries/surgery ; Esthetics ; Female ; Humans ; Mammaplasty/adverse effects ; Mammaplasty/methods ; Middle Aged ; Perforator Flap/blood supply ; Postoperative Complications ; Retrospective Studies ; Young Adult
    Language English
    Publishing date 2017-06
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2017.03.011
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  6. Article ; Online: Immediate nipple reconstruction during skin-sparing mastectomy utilising the nipple sharing technique and harvesting the nipple graft from the mastectomy specimen.

    Plonczak, Agata M / Henry, Francis P / Hadjiminas, Demetrios J / Wood, Simon H

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2017  Volume 71, Issue 5, Page(s) 775–776

    MeSH term(s) Adult ; Breast Neoplasms/surgery ; Esthetics ; Female ; Humans ; Mammaplasty/methods ; Mastectomy/methods ; Middle Aged ; Nipples/transplantation ; Surgical Flaps/blood supply
    Language English
    Publishing date 2017-11-28
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2017.11.027
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  7. Article ; Online: The incidence of facial vessel agenesis in patients with syndromic congenital facial palsy.

    Butler, Daniel P / Henry, Francis P / Leckenby, Jonathan I / Grobbelaar, Adriaan O

    Plastic and reconstructive surgery

    2015  Volume 134, Issue 6, Page(s) 955e–958e

    Abstract: Background: Congenital facial palsy can result in significant disfigurement. A potential treatment option is free functional muscle transfer to reanimate the face. For this to be possible, a suitable recipient artery and vein must be present in the ... ...

    Abstract Background: Congenital facial palsy can result in significant disfigurement. A potential treatment option is free functional muscle transfer to reanimate the face. For this to be possible, a suitable recipient artery and vein must be present in the affected hemiface. In this study, the authors aim to identify whether patients with syndromic congenital facial palsy have a higher rate of facial vessel agenesis than those with isolated congenital facial palsy.
    Methods: Patients were identified between November of 2006 and October of 2013. Patients were stratified into two groups: those with syndromic congenital facial palsy and those with isolated congenital facial palsy. The presence or absence of facial vessels was determined intraoperatively.
    Results: Forty-seven eligible patients were included in the study. Those with syndromic congenital facial palsy were significantly more likely to have an absent facial vein than patients with isolated congenital facial palsy (p = 0.015). There was a strong trend toward those with syndromic facial palsy lacking a facial artery (p = 0.08). Subgroup analysis of patients with Möbius syndrome revealed that these patients were significantly more likely to have facial artery agenesis than those with isolated congenital facial palsy (p = 0.03).
    Conclusions: Facial vessel agenesis is significantly more common in patients with syndromic congenital facial palsy compared with those with isolated congenital facial palsy. This must be considered in the preoperative planning for facial reanimation with free functional muscle transfer. The operating surgeon should consider vascular studies of the affected hemiface before undertaking the procedure.
    MeSH term(s) Abnormalities, Multiple/pathology ; Abnormalities, Multiple/surgery ; Adolescent ; CHARGE Syndrome/pathology ; CHARGE Syndrome/surgery ; Case-Control Studies ; Child ; Face/abnormalities ; Face/blood supply ; Face/surgery ; Facial Paralysis/congenital ; Facial Paralysis/pathology ; Facial Paralysis/surgery ; Free Tissue Flaps ; Goldenhar Syndrome/pathology ; Goldenhar Syndrome/surgery ; Humans ; Incidence ; Mobius Syndrome/pathology ; Mobius Syndrome/surgery ; Poland Syndrome/pathology ; Poland Syndrome/surgery ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; Vascular Malformations/epidemiology ; Vascular Malformations/etiology ; Vascular Malformations/pathology ; Young Adult
    Language English
    Publishing date 2015-02-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208012-6
    ISSN 1529-4242 ; 0032-1052 ; 0096-8501
    ISSN (online) 1529-4242
    ISSN 0032-1052 ; 0096-8501
    DOI 10.1097/PRS.0000000000000731
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  8. Article ; Online: Is there an ideal outcome scoring system for facial reanimation surgery? A review of current methods and suggestions for future publications.

    Niziol, Rafal / Henry, Francis P / Leckenby, Jonathan I / Grobbelaar, Adriaan O

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2015  Volume 68, Issue 4, Page(s) 447–456

    Abstract: Facial reanimation is the surgical process of attempting to restore dynamic, spontaneous symmetry to the paralysed face. We undertook to review the most frequently used scoring systems and discuss a universal set of assessments which every facial palsy ... ...

    Abstract Facial reanimation is the surgical process of attempting to restore dynamic, spontaneous symmetry to the paralysed face. We undertook to review the most frequently used scoring systems and discuss a universal set of assessments which every facial palsy surgeon can use to standardize the outcome of surgical intervention and allow a comparison to be drawn when comparing different operative techniques. A literature review was performed using PubMed and Cochrane databases to identify scoring systems for facial palsy, facial nerve regeneration and facial reanimation. The scoring systems were broken down into the following broad categories: observational, mathematical and computer-graphical measurements. More than 20 scoring systems were identified and included in the study. The scoring systems were analysed and assessed for reproducibility and inter-observer reliability. The current trend in the literature is to use the House-Brackmann Score due to its historical longevity, brevity and ease of understanding. However, this was never designed to assess outcomes of facial reanimation and there are clear limitations. Other more appropriate methods such as 3-D facial analysis are prohibitively expensive to widely implement. The quest continues to develop an ideal system. From this review it is clear that a quick, simple to use system should be used which incorporates the patient's own views. Therefore a combination of pre- and post-operative photographs of the patient should be assessed by an independent panel as well as the patient. We propose a universal set of photographs that can be used to standardize the outcome of surgical intervention when publishing results in the literature. This will allow a comparison to be drawn when comparing different operative techniques and help surgeons work collectively towards the same goal while improving patient outcomes.
    MeSH term(s) Facial Expression ; Facial Nerve/physiology ; Facial Paralysis/surgery ; Humans ; Nerve Regeneration/physiology ; Outcome Assessment (Health Care)/methods ; Photography ; Surgery, Plastic
    Language English
    Publishing date 2015-04
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2014.12.015
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  9. Article ; Online: Lengthening temporalis myoplasty: outcome and radiographic anatomical evaluation of length required.

    Butler, Daniel P / Kanagarajah, Lakshmi / Henry, Francis P / Grobbelaar, Adriaan O

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2015  Volume 68, Issue 4, Page(s) 585

    MeSH term(s) Facial Paralysis/surgery ; Female ; Humans ; Male ; Reconstructive Surgical Procedures/methods ; Temporal Muscle/anatomy & histology ; Temporal Muscle/diagnostic imaging ; Temporal Muscle/surgery ; Tomography, X-Ray Computed
    Language English
    Publishing date 2015-04
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2014.12.009
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  10. Article ; Online: The perils of spinning class: an open ankle fracture following a spinning exercise session.

    Butler, Daniel P / Henry, Francis P / Ghali, Shadi

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2013  Volume 66, Issue 12, Page(s) 1801–1802

    Abstract: Spinning is an increasingly popular form of cycle-based exercise. The workouts are often of high-intensity and participants are intermittently encouraged to achieve a high crank-set-cadence rate. We report a unique case of an open ankle fracture ... ...

    Abstract Spinning is an increasingly popular form of cycle-based exercise. The workouts are often of high-intensity and participants are intermittently encouraged to achieve a high crank-set-cadence rate. We report a unique case of an open ankle fracture requiring free flap coverage, which highlights the potential perils of spinning class.
    MeSH term(s) Ankle Fractures ; Ankle Injuries/surgery ; Bicycling/injuries ; Debridement ; Exercise ; Female ; Fractures, Open/surgery ; Humans ; Middle Aged
    Language English
    Publishing date 2013-12
    Publishing country Netherlands
    Document type Case Reports ; Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2013.05.036
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