Abstracts
3
Material and methods: A prospective study of 85 patients un-
dergoing cleft palate repair by the North Thames Cleft Team over a
period of 18 months. Biopsies were taken of the palatopharyngeus
and/or levator veli palatini muscles at the time of surgery. These
biopsies have been investigated by a panel of histological and
immunohistochemical methods. Patients were divided into groups
according to the type of cleft or associated syndrome. Results have
been quantified using “Definiens” digital image analysis software.
Results: In concordance with previous cadaveric studies pala-
topharyngeus and levator veli palatini were seen to be structurally
very different. Fast muscle fibres predominate in the majority of
palatopharyngeus biopsies in contrast to slow fibres in levator veli
palatini. In 2 groups of patients, those with submucous cleft palate
or Pierre Robin sequence, the palate muscles were structurally
different to cadaveric and control muscles with muscle fibres being
replaced by fibro-fatty tissue and abnormalities of fibre types.
Conclusions: In patients with submucous cleft palate or Pierre
Robin sequence there are structural palatal muscle abnormalities
which may contribute to velopharyngeal insufficiency.
AUTOLOGOUS FAT GRAFTING FOR THE TREATMENT
OF FUNCTIONAL AND COSMETIC ASPECTS OF BURN
CONTRACTURE
Miriam Byrne, Michelle O’ Donnell, Lisa Fitzgerald,
Odhran Shelley
St. James’s Hospital, Ireland
Introduction and aims: Burn Scars present a formidable chal-
lenge for the reconstructive Surgeon. They commonly impair
function, limit movement and cause disfigurement, due to the scar
itself and contour abnormalities. Structural fat grafting may
directly improve contour with potential benefits of favourable scar
modulation due to the high proportion of adipose derived stem
cells. We report our initial experience in the burns setting.
Material and methods: Data was collected prospectively on 20
patients. Inclusion criteria patients with decreased range of motion
and disfiguring contour defects. Poor compliers excluded. Preop-
erative Hand Therapy assessment and completion of DASH, and
Michigan scores with measurement of Total Active Range of Motion,
and Grip strength.
Results: 11 female, 9 male, with an average age (36years),
following lipofilling for debilitating disfiguring burn scars of the upper
limb (13) and head and neck (7) between 2012-2013 were included.
Time to follow up (6.4mths) and time from original injury (2.6years)
were recorded. Significant increases noted in Total Active Motion (by
24 degrees) and overall patient satisfaction (p< 0.001), but not in
DASH, or Michigan scores or grip strength pre and post fat grafting.
Conclusion(s): Lipofilling plays a definite role in scar modula-
tion in the burns setting, and is well tolerated, associated with high
patient satisfaction and minimal donor site morbidity. It has the
potential to be a treatment of choice to improve post burn scars,
appearance and contracture.
EPIDEMIOLOGICAL FACTORS & SHOULDER OUTCOME
OF PATIENTS WITH UNILATERAL OBSTETRIC
BRACHIAL PLEXUS INJURY IN SCOTTISH
POPULATION
Andrew R. McKean 1, Mark Gorman 2,
Timothy E.J. Hems 3, Andrew M. Hart 2,3,4
1
University of Glasgow, United Kingdom
2
Canniesburn Plastic Surgery Unit, United Kingdom
1467
Scottish National Obstetric Brachial Plexus Injury Service, United
Kingdom
4
Stephen Forrest Professor of Plastic Surgery at University of
Glasgow, United Kingdom
Introduction and aims: Reported incidence figures are lacking
for obstetric brachial plexus injury (OBPI) in the UK, and the exact
outcome for these patients remains inadequately defined at the
population level. That impacts adversely upon patient & parental
counselling and support, and creates difficulty in obtaining
adequate, equitable service-level funding within the NHS.
Material and methods: The Scottish National Obstetric Brachial
Plexus Injury Service prospectively records musculoskeletal and
plexus injury-specific outcomes. Records of patients presenting be-
tween March 2002 and June 2013 were retrospectively assessed
(nZ373; 127 excluded due to inadequate data, or incorrect diagnosis).
Birth incidence was estimated, and outcomes related to Narakas grade
and age at biceps function recovery were interrogated using SPSS.
Results: OBPI incidence was> 0.4 per 1000 live births. Discharge
from the service within the first year of life, indicating spontaneous
recovery, was achieved in >30% of all patients. Primary surgical
intervention was performed in 26% of cases. Approximately 5%
(nZ13) of the total study population had nerve surgery, at mean
age of 5.8 months (SDZ2.4). Further procedures were required in
38% (nZ5) of those who initially underwent nerve surgery. Narakas
Grade, and age at recovery of biceps were confirmed as prognostic
indices for future Mallet scores. The time-course of shoulder re-
covery is described.
Conclusion(s): Few units have managed to capture longitudinal
data for such large numbers of patients in to adolescence. The
long-term shoulder outcomes in patients undergoing nerve surgery
were encouraging. Nerve surgery was of benefit in severe cases.
THE IBRA STUDY: A NATIONAL MULTICENTRE AUDIT
OF THE OUTCOMES OF IMPLANT-BASED BREAST
RECONSTRUCTION WITH AND WITHOUT LOWER
POLE SUPPORT
Shelley Potter 1, Chris Holcombe 2, Seni Mylvaganam 3,
Steven Thrush 4, Lisa Whisker 5, Joanna Skillman 6,
The National Research Collaborative 7
1
University of Bristol, United Kingdom
2
Royal Liverpool and Broadgreen University Hospitals, United
Kingdom
3
University of Birmingham, United Kingdom
4
Worcestershire Royal Hospital, United Kingdom
5
Nottingham University Hospitals NHS Trust, United Kingdom
6
University Hospitals of Coventry and Warwickshire,
United Kingdom
7
National Research Collaborative, United Kingdom
Introduction: Implant-based breast reconstruction (IBBR) is the
most commonly-performed reconstructive procedure in the UK.
The introduction of techniques to augment the subpectoral pocket
with autologous (e.g dermal slings) and prosthetic materials (e.g.
acellular dermal matrix) has revolutionalised the procedure, but
there is a lack of high-quality outcome data to support the safety or
efficacy of these novel techniques.
The iBRA study aims to use the National Trainee Research
Collaborative Network (NTRCN) to define the current practice of
IBBR in the UK and audit the outcomes of the procedure against
quality standards defined by the National Mastectomy and Breast
Reconstruction Audit (NMBRA).
Methods: Trainee leads will be identified at all breast and
plastic surgical centres throughout the UK via the NTRCN.Trainee