Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Elizabeth Croll: ASPS Patient of Courage 2016

Summary:. Mrs. Elizabeth Croll was selected as an American Society of Plastic Surgeons (ASPS) Patient of Courage in 2016. During a boating accident that occurred within 1 month after graduating from Harvard Business School, she was struck by an oncoming boat and suffered severe facial trauma, resulting in an open skull injury with loss of her right eye. She has since undergone multiple reconstructive surgical procedures beginning in 1997 and continuing up to the month before she was awarded the ASPS Patient of Courage. During this time, she got married, started a family, and continued an ambitious business career. Mrs. Croll is the epitome of an individual who has overcome tragedy to further her career, her community, and access to medical care for indigent children

Biomaterials in craniofacial surgery: experimental studies and clinical application

The increasing variety of biomaterials available to the craniofacial surgeon today, with advantages of "off-the-shelf availability" and lack of donor-site morbidity, provides a formidable armamentarium for applications in reconstruction and augmentation. Although biomaterials are invaluable alternatives to autogenous bone graft, there is lack of uniformity in clinical application. In this article, we review our experience with the use of hydroxyapatite derivatives in animal studies and subsequently discuss our experience with the use of 3 classes of biomaterials (cement pastes, osteoactive biomaterials, and prefabricated polymers) for craniofacial reconstruction. We subsequently offer guidelines to dictate the choice of biomaterials for different applications, based on the site of reconstruction (onlay versus inlay reconstruction) and skeletal maturity

Mechanical analysis of resorbable plates for long-term soft-tissue molding

Resorbable plates are used with increasing frequency in pediatric craniofacial surgery. A recent innovation has been the use of these plates in long-term soft-tissue molding. However, these plates were not designed for these applications, and an unanswered question remains the mechanical rigidity and stability of the plate when placed in a prolonged out-of-plane bend. Ten varieties of resorbable plates were folded to a right angle and subjected to a standardized 80-g load at body temperature over a duration of 2 weeks. Angle height was measured as an index of the ability of the plate to maintain its out-of-plane bend against an axial force. Each plate was subjected to 3 successive tests, after bending back to its original configuration. All plates showed a progressive decrease in angle height over 2 weeks. Thickness of the plate appeared to correlate with mechanical rigidity and ability to maintain out-of-plane bend. The plates that performed the best were the Synthes PLGA (85/15) 1.2-mm and BioGeneral PLA (poly-D,L-lactic acid) 1.0-mm plates. Decrease in angle height occurred over shorter intervals in successive tests. Of all the plates tested, none were able to maintain initial out-of-plane bend over 2 weeks of testing. Further research and development by industry are required to optimize mechanical properties of resorbable plates for applications in soft-tissue molding

Double-Opposing Z-Plasty for Secondary Surgical Management of Velopharyngeal Insufficiency Following Primary Furlow Palatoplasty

The present study investigates the efficacy of performing a "palate rerepair" utilizing a double-opposing z-palatoplasty (DOZ) following primary Furlow palatoplasty. Retrospective study. Tertiary referral academic center for craniofacial surgery. 15 consecutive patients who presented with velopharyngeal insufficiency (VPI) after primary Furlow palatoplasty. All subjects were evaluated using the perceptual speech assessment (PSA) scale. Criteria for inclusion in the study were (1) velopharyngeal gap size on phonation of 7 mm or less and (2) lateral wall motion at least 40% normal. Mean PSA score was 7.13 + 3.31 (range 3-13) preoperatively, and decreased to 1.80 + 2.83 (range 0-11; P < .001 vs baseline) 3 months or more after surgery. A sphincter pharyngoplasty was performed as a tertiary procedure in 2 patients due to persistent nasal air emission. There was no symptomatic airway compromise following secondary or tertiary management in all patients. Presence of a cleft lip, lateral wall motion, and velopharyngeal gap size did not impact outcomes. We have demonstrated that a DOZ performed secondarily is anatomically possible following Furlow palatoplasty and can restore function of the levator muscle despite significant scarring following primary repair. This approach respects anatomic principles of palatoplasty without eliminating the possibility for extrapalatal procedures should velopharyngeal competence not be achieved