Cranioplasty: A New Perspective

AIM: This work aims to present the different indication, benefits, possible complications and methods used for fixation of methyl methacrylate in cranioplasty. Also, 50 cases will be presented demonstrating the different aetiologies of the defects, and the different techniques used for fixation of methyl methacrylate in cranioplasty. METHODS: This investigation included a prospective study to be carried out on 50 patients with cranial defects of different aetiologies, sites and sizes to be operated upon in Cairo University Hospitals starting from August 2016 to April 2017.RESULTS: The principal aims of cranioplasty in this study are to restore aesthetic contour and to provide cerebral protection. However, it has been noted that a great improvement occurs in cerebral blood flow and cerebral perfusion after cranioplasty. CONCLUSION: Ball and socket technique appear to be a simple, safe economic and efficient method for fixation of cranioplasty flap. The high incidence of development of postoperative seroma suggests the necessity of-of a subgaleal drain placement for 48 hours. &nbsp

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