Early outcome of facial reconstructive surgery abroad: a comparative study

Every year, many medical missions are undertaken in the developing world but there is almost a universal lack of outcome data on the quality of these missions. The present study compares early clinical outcome and complication rate in two consecutive missions (facial reconstruction) undertaken to Ethiopia in 2007 and 2008. The object was to establish if measures adopted following feedback from the first mission led to improvement of the results. A significant improvement was observed in early clinical outcome and there were less severe complications in the 2008 compared to the 2007 mission. On both occasions, significantly more complications were experienced after complex compared to simple procedures. Despite improved outcome in 2008, 50% of the complex cases had an unfavourable clinical result. The data suggest that early outcome studies are a useful method of critically evaluating the quality of surgical mission. The unsatisfactory outcome of complex procedures underlines the need for feedback on the quality of these missions

NOMA: A Preventable “Scourge” of African Children

Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma

Der muskuläre und der neue osteomuskuläre Peroneus brevis Composite Lappen: 109 Rekonstruktionen rund ums Sprunggelenk

Dantzig-Wolfe reformulation of a mixed integer program partially convexifies a subset of the constraints, i.e., it implicitly adds all valid inequalities for the associated integer hull. Projecting an optimal basic solution of the reformulation’s LP relaxation to the original space does is in general not yield a basic solution of the original LP relaxation. Cutting planes in the original problem that are separated using a basis like Gomory mixed integer cuts are therefore not directly applicable. Range [22] (and others) proposed as a remedy to heuristically compute a basic solution and separate this auxiliary solution also with cutting planes that stem from a basis. This might not only cut off the auxiliary solution, but also the solution we originally wanted to separate. We discuss and extend Range’s ideas to enhance the separation procedure. In particular, we present alternative heuristics and consider additional valid inequalities strengthening the original LP relaxation before sepa-ration. Our full implementation, which is the first of its kind, is done within the GCG framework. We evaluated the effects on several problem classes. Our experiments show that the separated cuts strengthen the formulation on instances where the integrality gap is not too small. This leads to a reduced number of nodes and reduced solution times