Papers by Christopher Abela
British Journal of Surgery, 2021
Subcutaneous emphysema is a common entity following facial trauma. However, pneumomediastinum sec... more Subcutaneous emphysema is a common entity following facial trauma. However, pneumomediastinum secondary to isolated facial fractures is a rare and potentially life-threatening complication. We present a case of a 26-year-old female that presented with sudden onset left sided facial swelling over the left periorbital and zygomaticomaxillary region and some bruising overlying the left maxilla. In addition to palpable crepitus that was present over the left temporal and left supraclavicular regions following blunt trauma. There was no associated difficulty breathing or dysphagia and it was unclear whether she had blown her nose earlier that day. Computed tomography confirmed the diagnosis and extension of the pneumomediastinum. In conclusion, pneumomediastinum is a rare complication of blunt facial trauma. Prophylactic antibiotics should be considered to reduce the risk of mediastinitis and nose blowing should be avoided. Due to a lack of clear guidelines when managing this condition, ...
Einleitung: Große Hautdefekte der Stirn und des Kopfe gleich welcher Entität sind in vielen Fälle... more Einleitung: Große Hautdefekte der Stirn und des Kopfe gleich welcher Entität sind in vielen Fällen nicht durch einen primären Wundverschluss zu versorgen, da die Haut in diesem anatomischen Bereich wenig elastisch ist. Traditionelle Rekonstruktionsmöglichkeiten umfassen die Vollhauttransplantation, lokale gestielte Lappen wie beispielsweise transpositions- und Rotationslappen, Implantation von Haut- und Gewebeexpandern mit anschliessendem Wundverschluss sowie freie Lappen. Hautdefekte bei älteren Patienten sind in den meisten Fällen posttraumatisch oder postoperativ. Bei großen postoperativen Defekten wird in vielen Fällen die sekundäre Wundheilung angestrebt. Diese wird teilweise mit Granulationsanreizen, wie dem Anbohren der Kalotte, unterstützt. Die Wundheilung ist langfristig, mehrfache Verbandswechsel sind notwendig und das kosmetische Ergebnis ist meist nicht optimal. Material und Methoden: Um Entfernung und Rekonstruktion von großen Basaliomen der Kopfhaut bei 3 älteren männl...
British Journal of Hospital Medicine, 2021
There is a vast number of wound dressings to choose from, which can make selecting the most suita... more There is a vast number of wound dressings to choose from, which can make selecting the most suitable dressing for a wound a daunting prospect. This article highlights how the wound can guide the doctor's decision. Although all wound dressings are intended to achieve optimal wound healing and protection from contamination, they do so to varying degrees depending on the qualities of the dressing and the wound itself. This article looks at a range of dressings, from traditional to newer dressings, and evaluates their benefits and contraindications to help determine where they are best suited for use in wound management.
Clinical Otolaryngology, 2021
This study examines the histological findings of tracheal tissue samples obtained from COVID‐19 p... more This study examines the histological findings of tracheal tissue samples obtained from COVID‐19 positive mechanically ventilated patients, to assess the degree of tracheal inflammation/ulceration present.
European Journal of Cancer, 2016
Purpose: Head and neck rhabdomyosarcoma (HNRMS) survivors are at increased risk of developing pit... more Purpose: Head and neck rhabdomyosarcoma (HNRMS) survivors are at increased risk of developing pituitary dysfunction as an adverse event of radiotherapy. Our aim was to investigate the frequency and risk factors for pituitary dysfunction in these survivors. Secondly, we aimed to compare the prevalence of pituitary dysfunction between survivors treated with external beam radiation therapy (EBRT) and survivors treated with the ablative surgery, moulage technique after loading brachytherapy, and surgical reconstruction (AMORE) procedure. Methods: Eighty HNRMS survivors treated in London (EBRT based) and Amsterdam (AMORE based: AMORE if feasible, otherwise EBRT) in the period 1990e2010 and alive !2 years post-treatment were evaluated. Survivors were evaluated in multidisciplinary late-effects clinics, with measurement of linear growth, determination of thyroid function, and growth hormone parameters. Additional data, such as baseline characteristics, anthropometrics, pubertal stage, and the results of additional laboratory investigations, were retrieved from patient charts. Results: Pituitary dysfunction was diagnosed in 24 in 80 (30%) survivors, after a median follow-up time of 11 years. Median time to develop pituitary dysfunction after HNRMS diagnosis was 3.0 years. Risk factors were EBRT-based therapy (odds ratio [OR] 2.06; 95% confidence interval [CI] 1.79e2.46), parameningeal tumour site (OR 1.83; 95% CI 1.60e2.17) and embryonal RMS histology (OR 1.49; 95% CI 1.19e1.90). Conclusions: Radiotherapy used for the treatment of HNRMS confers a significant risk of the development of pituitary dysfunction. AMORE-based treatment in children with HNRMS resulted in less pituitary dysfunction than treatment with conventional EBRT. Our findings underscore the importance of routine early endocrine follow-up in this specific population.
Oxford Textbook of Plastic and Reconstructive Surgery, 2021
The abdominoplasty or ‘tummy tuck’ is one of the most commonly requested aesthetic procedures and... more The abdominoplasty or ‘tummy tuck’ is one of the most commonly requested aesthetic procedures and refers to a variety of surgical techniques. A detailed understanding of the surgical anatomy, deformity, the components that need redress, and the clinical decision-making algorithms are essential. Meticulous attention to perioperative optimization mitigates risk and complications. The evolution of the surgical techniques is ongoing particularly following the increased demand from massive weight-loss patients.
The Annals of The Royal College of Surgeons of England, 2007
Excellent review that not only highlights the history and evidence for sentinel node biopsy (SNB)... more Excellent review that not only highlights the history and evidence for sentinel node biopsy (SNB), but discusses the technical limitations, practical hurdles and accuracy of the procedure in patients with breast cancer. The site is pragmatic and well supported with its evidence base and reference list. This is a comprehensive and readily readable introduction to the subject. It is useful for clinicians and patients alike and delivers a good platform of knowledge.*****
The Annals of The Royal College of Surgeons of England, 2006
European Journal of Cancer, 2015
Radiotherapy is a well-known cause of adverse events (AEs). To reduce AEs, an innovative local tr... more Radiotherapy is a well-known cause of adverse events (AEs). To reduce AEs, an innovative local treatment was developed in Amsterdam: Ablative surgery, MOuld brachytherapy and surgical REconstruction (AMORE). (1) to determine the prevalence of AEs in HNRMS survivors and (2) to compare AEs between survivors treated with the international standard: external beam radiotherapy (EBRT-based: London) and survivors treated with AMORE if feasible, otherwise EBRT (AMORE-based: Amsterdam). All HNRMS survivors, treated in London or Amsterdam between January 1990 and December 2010 (n=153), and alive ⩾2years post-treatment were eligible (n=113). A predefined list of AEs was assessed in a multidisciplinary clinic and graded according to the Common Terminology Criteria for Adverse Events. Eighty HNRMS survivors attended the clinic (median follow-up 10.5years); 63% experienced ⩾1 severe or disabling event, and 76% had ⩾5 AEs (any grade). Survivors with EBRT-based treatment were, after adjustment for site, age at diagnosis, and follow-up duration, at increased risk to develop any grade 3/4 event or ⩾5 AEs (any grade) compared with survivors with AMORE-based treatments (p=0.032 and 0.01, respectively). Five year overall survival (source population) after EBRT-based treatment was 75.0%, after AMORE-based treatment 76.9%, p=0.56. This study may serve as a baseline inventory and can be used in future studies for prospective assessments of AEs following the introduction of novel local treatment modalities. AMORE-based local treatment resulted in similar overall survival and a reduction of AEs secondary to local treatment.
Seminars in plastic surgery, 2014
The techniques of frontofacial surgery are most valuable in the clinical management of complex cr... more The techniques of frontofacial surgery are most valuable in the clinical management of complex craniofacial deformity to achieve a range of functional and aesthetic gains in children from infancy to maturity. A variety of complex craniofacial osteotomies that can be used to separate the orbits from the skull base have been described. In addition, the combination of circumorbital release and pterygomaxillary disjunction allows advancement of the orbitomaxillary segment for powerful clinical benefit. For the purpose of this article, the principal frontofacial strategies include the monobloc frontofacial advancement by distraction (MBD), frontofacial bipartition advancement by distraction (BpD), orbital box osteotomy (FFBx), and frontofacial bipartition (FFBp). These techniques are broadly used for two purposes: to allow for the translocation of one or both orbits to correct orbitofacial disproportion (hypertelorism, vertical orbital dystopia, or a combination of both), or to advance t...
British Journal of Oral and Maxillofacial Surgery, 2014
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
We discuss an extremely unusual presentation of a 19-month-old child with cor triatriatum and an ... more We discuss an extremely unusual presentation of a 19-month-old child with cor triatriatum and an intact interatrial septum, who presented for the first time at the age of 16 months with wheezing and repeated lower respiratory tract infections. At surgery, a thick fibromuscular membrane with a 2-3 mm eccentrically placed orifice was identified, and following surgical resection of the membrane the child made an uneventful recovery. This case demonstrates the need for investigating children with "asthma" who do not respond to conventional medical management. A rare but potentially correctable underlying cause may be found.
Pathophysiology, 2003
Ischaemia-reperfusion injury (IRI) is a complex interplay between biochemical, cellular, and vasc... more Ischaemia-reperfusion injury (IRI) is a complex interplay between biochemical, cellular, and vascular endothelial factors. The clinical sequelae are organ specific, and may also involve systemic inflammatory responses. In this article, we outline an overview of the pathophysiology of IRI, with direct reference to histological and physiological changes seen in individual organs, and present the data on experimental methods of prevention.
The Journal of Craniofacial Surgery, 2015
Hypertelorism may be corrected by either transcranial box osteotomy or facial bipartition. Despit... more Hypertelorism may be corrected by either transcranial box osteotomy or facial bipartition. Despite radical bony resection, the associated soft tissue translation often seems disproportionate. The purpose of this study was to review bony and soft tissue movements in a series of 15 consecutive hypertelorism correction cases. Two surgical residents in training independently analyzed preoperative and postoperative axial and three-dimensional reconstructed computed tomography data from 15 consecutive patients undergoing facial bipartition (n = 7) or transcranial box osteotomy correction (n = 8) between 2001 and 2010. Anterior interorbital distance, lateral interorbital distance, midpoint globe distance, and globe protrusion were measured along with intercanthal distance and palpebral fissure width. The mean preoperative anterior interorbital distance was 35.5 mm; postoperatively, there was a mean reduction of 9.5 mm, to 26 mm. The mean preoperative intercanthal distance was 48.1 mm; there was a mean reduction of 10.3 mm, to 37.8 mm. The mean preoperative midpoint globe distance was 69.5 mm; there was a mean reduction of 9.6 mm, to 59.9 mm. The mean preoperative globe protrusion was 17.6 mm; there was a mean reduction of 5 mm, to 12.6 mm (28.5%). The mean interclass correlation (a measurement of interrater congruency with 1 being complete agreement) was 0.85 CONCLUSIONS: Transcranial box osteotomy and facial bipartition correct hypertelorism. The medial canthal tendons, lateral canthal tendons, and globes move in proportion to the bony attachments. We observed a reduction in globe protrusion an average of 29%, therefore risking enophthalmos.
Plastic and Reconstructive Surgery, 2012
Plastic and Reconstructive Surgery, 2013
Bipartition distraction is a novel procedure combining frontofacial bipartition and monobloc dist... more Bipartition distraction is a novel procedure combining frontofacial bipartition and monobloc distraction. Apert syndrome and other syndromic craniofacial dysostoses are often characterized by hypertelorism, with a negative canthal axis and counterrotated orbits. Central midface hypoplasia can result in a biconcave face in both midsagittal and axial planes. Bipartition distraction can correct these facial abnormalities. Twenty patients (19 Apert syndrome patients and one Pfeiffer syndrome patient, aged 1.6 to 21 years) underwent bipartition distraction. Severity of appearance was graded preoperatively and postoperatively as mild, moderate, or severe. Functional problems were documented by a multidisciplinary team. Central and lateral midface skeletal advancement were measured. Follow-up ranged from 15 months to 7 years. Bipartition distraction consistently produced more central than lateral facial advancement. Mean central advancement was 13.2 ± 5.9 mm at sella-nasion and 11.7 ± 5.4 mm at sella-A point. Lateral advancement was 4.7 ± 2.8 mm. Unbending the face improved aesthetic appearance. Airway function, eye exposure, and elevated intracranial pressure were improved. Complications included six temporary cerebrospinal fluid leaks (four needing a lumbar drain), five patients with postoperative seizures, five patients requiring Rigid External Distraction frame repositioning, one palatal fistula, one velopharyngeal incompetence, five pin-site infections, one abscess under frontal bone, three cases of sepsis, nine patients with worsened strabismus, two patients with enophthalmos, one patient with partial visual field loss, and three patients who required reintubation because of aspiration. : Bipartition distraction is an effective procedure with which to differentially advance the central face in Apert syndrome. It improves both function and aesthetics. : Therapeutic, IV.
Journal of Neurology, Neurosurgery & Psychiatry, 2012
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Papers by Christopher Abela