Wise versus vertical mastopexy pattern skin-reducing mastectomy with immediate breast reconstruction: systematic review and meta-analysis

Background: This study compares postoperative outcomes of Wise and vertical mastopexy pattern skin-reducing/skin-sparing masctomy, hypothesizing that incision choice affects cosmetic outcomes and complication rates. Methods: A systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, MEDLINE, Embase, Web of Science, and StarPlus Library. Included studies documented skin-sparing mastectomy using Wise or vertical mastopexy patterns with immediate reconstruction. The primary outcome is total mastectomy flap necrosis. The secondary outcomes are major/minor necrosis, infection, hematoma, seroma, and wound complications. Bayesian and frequentist generalized linear mixed models were used for the meta-analysis, including studies with 0 events. Results: Sixty-six studies were identified, with 39 included in the meta-analysis, comprising 1954 patients and 2311 breast reconstruction cases. The Wise group had a higher rate of mastectomy flap necrosis (14.2%; 95% confidence interval: 10%–20%; I² = 83%) compared with the vertical group (7.8%; 95% confidence interval: 5%–12%; I² = 0%) (P < 0.05). No significant differences were found in other domains. Subgroup analysis favored vertical mastopexy for wound-related complications (P = 0.04). Conclusions: The Wise pattern shows significantly higher mastectomy flap necrosis than the vertical pattern. However, there were no significant differences in major necrosis, minor necrosis, infection, hematoma, or seroma. Future studies should focus on larger, high-quality randomized controlled trials to better understand the impact of incision techniques on postoperative outcomes

Risk factors associated with short-term complications in mandibular fractures: the MANTRA study—a Maxillofacial Trainee Research Collaborative (MTReC)

Abstract Introduction Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. Methods The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Results Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. Discussion We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications. </jats:sec

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR) : an international multicentre prospective cohort study

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary

Evaluation of nurse-midwives practices related to the preventive measures for TORCH diseases in maternity teaching hospitals in Babylon Province/Iraq

Background: Some infections are more common, but all of them need to be prevented as the primary infections of Toxoplasma, other infections (like a varicella-zoster virus, hepatitis B), Rubella, Cytomegalovirus, and herpes simplex virus (TORCH) diseases. Objectives: to evaluate nurse-midwives’ practices and to find out the relationship between nurse-midwives’ practices and demographic characteristics. A descriptive design study was conducted on (138) nurse-midwives in maternity teaching hospitals in Babylon province using observation checklist questionnaires. The data were analyzed by using descriptive statistics (frequency and percentage). A chi-square test was used to analyze categorical variables. The P-value was determined using a P-value of 0.05 to determine statistical significance. The majority of the sample (37.7%) was reported to be between the ages of (21 and 30) years. The majority of the study participants (69.6%) had no prior knowledge of TORCH diseases. The level of knowledge regarding TORCH disease prevention measures was low (63% of nurse-midwives). A significant relationship between nurse-midwives’ practices of TORCH diseases and their years of experience and training sessions at a p-value of (0.05). </jats:p

Nurse-midwives’ knowledge related to the preventive measures for TORCH diseases in maternity teaching hospitals in Babylon Province/ Iraq

TORCH infections cause congenital anomalies throughout the gestation period that can cross the placenta and damage the fetus. The study aimed to assess the nurse midwife’s knowledge regarding preventive measures for TORCH infections. A descriptive design study was conducted on 138 nurse-midwives in maternity teaching hospitals in Babylon province using self-administered questionnaires. The data were analyzed by using descriptive statistics (frequency and percentage). A chi-square test was used to analyze categorical variables. The P-value was determined using a P-value of 0.05 to determine statistical significance. Results: The mean age and standard deviation (SD) for nurse-midwives in the study was 34.11+8.967; the majority of the sample was (37.7%) reported at age 21–30 years. The majority of the study participants (69.6%) had no prior knowledge of TORCH diseases. The level of knowledge about TORCH disease prevention is low.93% of nurse-midwives had moderate knowledge. There was a significant relationship between nurse-midwives’ knowledge of TORCH diseases and their education level, their years of experience, and training sessions at a p-value of 0.05. </jats:p

Nurse-midwives’ knowledge related to the preventive measures for TORCH diseases in maternity teaching hospitals in Babylon Province/ Iraq

TORCH infections cause congenital anomalies throughout the gestation period that can cross the placenta and damage the fetus. The study aimed to assess the nurse midwife’s knowledge regarding preventive measures for TORCH infections. A descriptive design study was conducted on 138 nurse-midwives in maternity teaching hospitals in Babylon province using self-administered questionnaires. The data were analyzed by using descriptive statistics (frequency and percentage). A chi-square test was used to analyze categorical variables. The P-value was determined using a P-value of 0.05 to determine statistical significance. Results: The mean age and standard deviation (SD) for nurse-midwives in the study was 34.11+8.967; the majority of the sample was (37.7%) reported at age 21–30 years. The majority of the study participants (69.6%) had no prior knowledge of TORCH diseases. The level of knowledge about TORCH disease prevention is low.93% of nurse-midwives had moderate knowledge. There was a significant relationship between nurse-midwives’ knowledge of TORCH diseases and their education level, their years of experience, and training sessions at a p-value of 0.05.&nbsp

Evaluation of nurse-midwives practices related to the preventive measures for TORCH diseases in maternity teaching hospitals in Babylon Province/Iraq

Background: Some infections are more common, but all of them need to be prevented as the primary infections of Toxoplasma, other infections (like a varicella-zoster virus, hepatitis B), Rubella, Cytomegalovirus, and herpes simplex virus (TORCH) diseases. Objectives: to evaluate nurse-midwives’ practices and to find out the relationship between nurse-midwives’ practices and demographic characteristics. A descriptive design study was conducted on (138) nurse-midwives in maternity teaching hospitals in Babylon province using observation checklist questionnaires. The data were analyzed by using descriptive statistics (frequency and percentage). A chi-square test was used to analyze categorical variables. The P-value was determined using a P-value of 0.05 to determine statistical significance. The majority of the sample (37.7%) was reported to be between the ages of (21 and 30) years. The majority of the study participants (69.6%) had no prior knowledge of TORCH diseases. The level of knowledge regarding TORCH disease prevention measures was low (63% of nurse-midwives). A significant relationship between nurse-midwives’ practices of TORCH diseases and their years of experience and training sessions at a p-value of (0.05).&nbsp