Broomfield Hospital is an acute district general hospital in Chelmsford, Essex. It is managed by the Mid and South Essex NHS Foundation Trust.
INTRODUCTION:Blood loss during the surgical management of craniosynostosis surgery is common and frequently requires blood transfusion. Interventions such as minimally invasive surgical approaches have been developed to minimise blood loss, given the morbidity of haemorrhage and the adverse effects of transfusion. This study aimed to identify and characterise the most impactful studies relevant to blood loss and transfusion in surgery for craniosynostosis. METHODS:Articles were searched and screened using the Web of Science (WoS) core collection database using keywords related to "blood loss," "transfusion," and "craniosynostosis." The most cited 100 relevant articles published in the English language were selected. Extracted data included WoS bibliographic and citation metrics, study characteristics and design, and keywords. Research theme and Level of Evidence (Oxford Centre of Evidence-Based Medicine) were ascertained. In-built tools on Google Sheets were used to perform and present descriptive statistics with bibliometric data and a citation-based review. RESULTS:The search returned 299 articles. The most cited relevant 100 articles were published between 1993 and 2022. The USA published the most articles (65%), followed by England (7%) and Canada (4%). The Journal of Craniofacial Surgery published the most articles (25%), followed by the Journal of Neurosurgery Paediatrics (17%) and Plastic and Reconstructive Surgery (10%). The most common research area (as categorised by WoS) was surgery (n=76), paediatrics (n=36), and neurosurgery (n=33). The most common research themes were endoscopic or minimally invasive interventions (31%), blood loss and transfusions (27%), and pharmacological interventions (21%). Most articles had a Level of Evidence of III (49%) or IV (22%). CONCLUSION:This novel analysis and review highlights the most influential articles in this field, as well as key themes that have shaped current clinical practice. These insights may help clinicians, researchers, and policymakers who continue to evaluate the surgical management of craniosynostosis.
Facial trauma is commonly encountered in the paediatric population, with its prevalence and severity influenced by age, the unique characteristics of developing facial anatomy and injury mechanism. A thorough yet targeted history, along with a detailed clinical examination during the initial evaluation in the emergency department (ED), is essential for effective management. This article provides an overview of facial fractures; mandibular, nasal, orbital, zygomatic and maxillary-with a specific focus on their assessment and management in the ED setting.
[This corrects the article DOI: 10.1016/j.jpra.2025.02.013.].
BACKGROUND:Wire-guided localizations have been the historical standard for breast lesion localization; however, they have logistical constraints and can dislodge in the preoperative period. Radar-guided localization has the potential to uncouple localization from the day of surgery, but the technique needs to be evaluated in a direct comparison with wire-guided localization to ensure efficacy and safety. METHODS:The iBRA-NET localization study is a prospective platform IDEAL 2a/2b study comparing wire-guided localization with new generation localization devices. This arm describes SCOUT® radar localization for impalpable breast lesions performed between June 2021 and December 2024, compared with a historical cohort of wire-guided localization performed between August 2018 and August 2020. Primary outcome was identification of the index lesion in the excision specimen. Secondary endpoints included safety (complications), margin re-excision, magnetic resonance imaging bloom size, and specimen weight. RESULTS:Data were accrued from 1297 radar localized patients in 27 units. Index lesion identification was 95.2% in radar-guided excisions versus 99.1% in wire-guided excisions (P = 0.001). In a sensitivity analysis excluding patients receiving neoadjuvant chemotherapy, identification rates were 98.9% versus 99.6% (P = 0.114). For a subset of patients having a simple lumpectomy for a unifocal, unilateral breast lesion with no neoadjuvant treatment (1627), positive margins were seen in the main excision specimen in 1003 (15.0%) wire-guided versus 624 (9.0%) radar-guided excisions (P < 0.001). Re-excision was required in 131 (13.2%) wire-guided versus 91 (14.7%) radar-guided excisions (P = 0.442). There was a significant difference in specimen weight/size2 (0.138 g/mm2 wire-guided localization versus 0.182 g/mm2 radar; P < 0.001). The median start time for surgery was earlier in the day for radar-guided localizations compared with wire-guided (12:27 versus 13:40; P < 0.001). All radar placements in axillary nodes (13) led to successful nodal retrieval. CONCLUSION:SCOUT® radar localizations are a safe and effective localization technique in both the breast and axilla, with outcomes comparable to wires. There were demonstrable logistical advantages in operative start time when using a radar reflector.
