A cadaveric study of first dorsal extensor compartment in Africans: Clinical implications

While several reports have been made regarding the anatomic variations in the first dorsal extensor compartment, very few have emanated from Africa.  This study looked at this compartment with respect to variations in the superficial branch of the radial nerve and the enclosed tendons. The first dorsal  extensor compartment of the hand was studied in 32 formalin preserved adult African cadavers. The superficial branch of the radial nerve emerged from  underneath the brachioradialis 8.4cm(sd±2.2cm) proximal to the radial styloid and branched 6.2cm (sd ±1.5cm) proximal to it as well. This nerve along  with the cephalic vein or its tributary transversed part of the compartment in all the hands. A double Extensor pollicis longus was found in one hand.  Septations were observed in 31.3 %(n=10) of the hands. Abductor pollicis longus tendon was fused in three hands, and had more than one slip in 94% of  the hands. A single extensor pollicis brevis tendon was found all dissected hands. Clinical implications of these findings are highlighted in this work.&nbsp

Complex Lower Extremity Reconstruction with Free Perforator Flap in a 20 Month Old Child

Free perforator flap reconstruction in toddlers is rare. A 20-month-old toddler sustained a complex ankle injury following a motor vehicle accident. At the initial debridement, a joint spanning external fixator frame was placed for ankle stabilization. The wound was covered with free anterolateral thigh flap a week later. Perforator free flap for complex lower extremity defects is feasible in very young children, even in low resource settings.

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways