Hyder Ridha - Academia.edu (original) (raw)

Papers by Hyder Ridha

Cureus, 2021

Flexor sheath infections (FSIs) are soft tissue infections affecting the hand, which, if mismanag... more Flexor sheath infections (FSIs) are soft tissue infections affecting the hand, which, if mismanaged, can have devastating consequences. Clinical assessment is key to diagnosis, with many relying on Kanavel cardinal signs as an aid. To prevent unnecessary operative intervention and the associated post-operative combined patient and healthcare burden, it is key that patients with FSIs are correctly identified. It would also be useful to stratify severity of FSIs without surgical exploration. To date, there is no accepted method to assist clinicians in doing so. We retrospectively analysed data from a five-year period to see if we could identify pre-operatively (a) accurate predictors of FSIs and (b) severity of the FSIs. We established that only the presence of all four Kanavel cardinal signs significantly predicted the presence of an FSI. No other variable that was available prior to surgery could predict either presence or severity of infection.

Journal of Reconstructive Microsurgery, 2019

Background Appropriate reconstruction of the posterolateral mandible remains controversial. Both ... more Background Appropriate reconstruction of the posterolateral mandible remains controversial. Both osseous and soft tissues are vital components for an overall successful outcome and are often combined in complex defects. Their respective effect on oromandibular function in the reconstruction of different degrees of mandibular defects has been less evaluated. Aim This study aimed to compare patient-perceived oromandibular function in osseous and soft tissue-only reconstructions following posterolateral mandibular defects, defined as limited or extended. Methods A 10-year retrospective review of consecutive patients undergoing mandibular reconstructions of the posterolateral mandible were identified. Limited defects were defined as reaching from the ipsilateral parasymphysis to anterior of the coronoid (sparing insertion of muscles of mastication). Extended defects were defined as reaching from the ipsilateral parasymphysis to posterior of the coronoid (sacrificing the muscle insertion...

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

Complete excision of high-risk extensive non-melanoma skin cancers in the head and neck is paramo... more Complete excision of high-risk extensive non-melanoma skin cancers in the head and neck is paramount to achieving loco-regional control. However, achieving clear margins still remains a significant challenge. Mohs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; micrographic surgery (MMS) provides the most accurate method of intraoperative mapping and histological assessment of tumour margins. We have developed a technique combining MMS with reconstruction as a single-stage procedure performed under general anaesthetic. We present our experience and results. Following regional skin cancer multidisciplinary team (MDT) discussion, patients considered appropriate for management as a single-stage combined procedure were referred for assessment. At surgery, a two-team approach was employed consisting of an MMS resection team and a reconstructive team, allowing simultaneous resection and elevation of any free tissue required for reconstruction. Outcome data were retrieved from a prospectively collated MMS database. Twenty-six cases were performed between January 2010 and January 2013. Fifty-eight percent of cases were basal cell carcinomas. Clear margins were achieved in 50% of cases following the first Mohs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; layer. Free tissue reconstruction was required in 13 cases. Mean anaesthetic time was 445 min. Loco-regional control was achieved in 96% of patients, at a mean follow-up period of 29 months (range 11-50 months). This study shows that the combined single-stage MMS and reconstruction surgical model is safe, results in a low recurrence rate and improved patient care. It is a model that can be replicated in other tertiary skin cancer units.

Annals of The Royal College of Surgeons of England

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2014

Annals of the Royal College of Surgeons of England, 2008

Buddy-strapping is a method of finger splinting that allows protected active movement in situatio... more Buddy-strapping is a method of finger splinting that allows protected active movement in situations such as stable phalangeal fractures, undisplaced stable metacarpal fractures and ligamentous interphalangeal joint injuries. We have found buddy-strapping with Tegaderm™ (3M Healthcare, Germany) a transparent adhesive dressing, has a number of advantages over tape. It is simple for patients to self-apply. A full range of movement is possible with full support provided throughout. The dressing is waterproof, easy to clean and does not discolour. Finally, it allows easy inspection and is cosmetically more appealing to patients. We have not found that it stretches. We describe a technique to help reduce the pain associated with transverse abdominal wall incisions (Fig. 1). During closure of the wounds, two 6-Ch PVC end-perforated 350 mm wound drains (Van Straten Medinorm, Nieuwegein, The Netherlands) are inserted deep to the internal oblique muscle (corresponding with the neurovascular bundle). The 'drain' exits laterally, 6-7 cm away from the transverse incision and away from any bone. It is stuck to the skin with two Vygon dermafilms (Dermafilm ® , Vygon, UK). Once closure is complete, 0.25% levobupivicaine is infiltrated via a pink (20-G) cannula affixed to the end of the drain as this minimises spillage. Further local anaesthesia can be instilled at the appropriate dose postoperatively using either boluses or continuous infusion via a pump (Bupivacaine Easypump, Braun, France). For the successful outcome of minimally invasive subtalar arthrodesis, skilful and accurate screw positioning are essential.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014

Background: Estimation of the volume of abdominal tissue is desirable when planning autologous ab... more Background: Estimation of the volume of abdominal tissue is desirable when planning autologous abdominal based breast reconstruction. However, this can be difficult clinically. The aim of this study was to develop a simple, yet reliable method of calculating the deep inferior epigastric artery perforator flap weight using the routine preoperative computed tomography angiogram (CTA) scan. Methods: Our mathematical formula is based on the shape of a DIEP flap resembling that of an isosceles triangular prism. Thus its volume can be calculated with a standard mathematical formula. Using bony landmarks three measurements were acquired from the CTA scan to calculate the flap weight. This was then compared to the actual flap weight harvested in both a retrospective feasibility and prospective study. Results: In the retrospective group 17 DIEP flaps in 17 patients were analyzed. Average predicted flap weight was 667 g (range 293e1254). The average actual flap weight was 657 g (range 300e1290) giving an average percentage error of 6.8% (p-value for weight difference 0.53). In the prospective group 15 DIEP flaps in 15 patients were analyzed. Average predicted flap weight was 618 g (range 320e925). The average actual flap weight was 624 g (range 356 e970) giving an average percentage error of 6.38% (p-value for weight difference 0.57). Conclusions: This formula is a quick, reliable and accurate way of estimating the volume of abdominal tissue using the preoperative CTA scan.

Journal of hand and microsurgery, 2011

A modification is presented to a commonly used type of improvised external fixator for hand fract... more A modification is presented to a commonly used type of improvised external fixator for hand fractures. Our modified fixator is easy to apply and allows fracture manipulation in three dimensions after application, before the cement sets.

Journal of Radiotherapy in Practice, 2011

We describe two cases of cellulitis occurring around ink sites, following tattooing for adjuvant ... more We describe two cases of cellulitis occurring around ink sites, following tattooing for adjuvant radiotherapy in two patients who had undergone latissimus dorsi-with-implant breast reconstructions. One patient was successfully treated with intravenous antibiotics. The second patient developed a peri-implant infection requiring implant removal. Patients with implant-based breast reconstructions should be warned of the potential infection risk of radiotherapy tattooing.

Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2005

To test the hypothesis that age-related loss of chondrocytes in cartilage is associated with impa... more To test the hypothesis that age-related loss of chondrocytes in cartilage is associated with impaired reactive oxygen species (ROS) homeostasis resulting from reduced antioxidant defence.

Microsurgery, 2005

Monitoring free-tissue transfers in the postoperative period is valuable for detection of failing... more Monitoring free-tissue transfers in the postoperative period is valuable for detection of failing flaps. As well as conventional methods, a myriad of sophisticated techniques have been reported in the literature. Using a postal questionnaire, a survey was conducted to delineate current protocols employed in UK plastic surgery units. Data were received from 148 plastic surgeons in 51 units. All surgeons used clinical assessment, although there was significant disparity in the duration and frequency of postoperative monitoring. Adjuvant techniques such as laser Doppler flowmetry were routinely used by less than 20% of surgeons. We conclude that there is considerable variation in postoperative monitoring of free flaps, with significant clinical and resource implications. A protocol based on robust evidence is thus recommended.

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2006

Dextran has been used in microsurgery to reduce the risk of free tissue transfer loss. A number o... more Dextran has been used in microsurgery to reduce the risk of free tissue transfer loss. A number of regimens which vary considerably in dosage and timing have been published in the literature. Using a postal questionnaire, a survey was conducted to delineate the current practise of UK plastic surgeons. Data were received from 161 plastic surgeons in 51 units (response rate of 61%). Forty-five percent of microsurgeons routinely use dextran post-operatively whilst 29% use alternative thromboprophylaxis. The indications, post-operative regimes and duration of administration of dextran vary significantly amongst surgeons and units. The reported success rates of free tissue transfer and digital replants were 97 and 85.1%, respectively, and was not significantly affected by the use of dextran. We conclude that there is considerable variation amongst UK plastic surgeons regarding thromboprophylaxis post microsurgery. Our data suggest that the use of dextrans does not affect free tissue tran...

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2007

A 4-year-old boy presented to our department with a darkly pigmented lesion on the right side of ... more A 4-year-old boy presented to our department with a darkly pigmented lesion on the right side of his neck. It was excised and a diagnosis of deep penetrating naevus with atypical features was made. At 4-month follow-up our patient had developed a palpable cervical lymph node. Excision revealed malignant melanoma. We discuss our management and review the literature regarding DPN and melanoma of childhood.

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2009

Gynaecomastia reduction surgery is a common male cosmetic procedure. Our clinical experience sugg... more Gynaecomastia reduction surgery is a common male cosmetic procedure. Our clinical experience suggested far lower rates of satisfaction than previously reported. Therefore we evaluated our patient group using a detailed questionnaire designed specifically to assess patient satisfaction with breast attributes and quality-of-life outcome following surgery. The questionnaire was sent to all patients who had surgery for gynaecomastia between January 2000 to January 2006. A total of 74 of the 120 patients contacted returned the questionnaire (62% overall response rate). The patients were divided into 3 groups according to their surgical treatment; liposuction only, excision only and combined excision plus liposuction. The majority of patients underwent surgery for reasons of self-confidence and emotional distress. In all groups surgery resulted in an increase in the mean Likert score (LS). The overall mean LS, combined from all the questions increased from 1.9 ('dissatisfied') t...

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2010

Cutaneous squamous cell carcinoma (SCC) is the second most common malignant skin tumour in the Eu... more Cutaneous squamous cell carcinoma (SCC) is the second most common malignant skin tumour in the European population, with an annual estimated age-standardised incidence of 1-6 per 1000. After the head and neck, the upper and lower limbs are the most common sites affected with 14% of SCCs occurring in these areas. SCC has the potential to be a highly aggressive tumour but there are no recent studies looking at the long-term outcome of patients with extremity SCC. A retrospective study was performed of 243 patients with a total of 517 upper and lower extremity SCCs who had been followed up for at least 4yrs. All patients' lesions were studied at one institution and data was collected from the Medical and Histopathology records. We found that there is only a low rate of recurrence or metastasis for extremity SCCs and that patients had a good prognosis overall.

Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2011

Chyle leakage post head-and-neck resection is a rare but potentially life-threatening complicatio... more Chyle leakage post head-and-neck resection is a rare but potentially life-threatening complication. Management may be problematic and prolonged. Recently, thoracoscopic ligation of the thoracic duct has emerged as a promising technique to definitively treat this difficult problem. We present a recent case of a hemimandibulectomy, radical modified neck dissection and osseocutaneous fibular-free-flap complicated by a chyle leakage. The chyle leak was successfully treated with thoracoscopic ligation of the thoracic duct. In the light of our clinical experience and following a thorough literature review, we have proposed that complicated or high-output chyle leaks (>1000 ml day(-1)) should be treated with early thoracoscopic thoracic duct ligation.

Journal of reconstructive microsurgery, 2011

Segmental defects of the distal femur following trauma pose a reconstructive challenge. A stable ... more Segmental defects of the distal femur following trauma pose a reconstructive challenge. A stable reconstruction capable of withstanding high forces while allowing early mobility is paramount. The Capanna technique of reconstruction combining allograft with vascularized bone graft provides such a construct and has been described for oncological resection. We describe a modified Capanna technique, the "inlay" construct. Three reconstructions were performed for distal femoral segmental loss following trauma. One patient had bilateral reconstructions. Bone defects measuring 11, 9, and 8 cm were reconstructed using a large segmental allograft and free fibular flap inlay assembly. Both patients made uneventful recoveries and achieved full weight-bearing without walking aids 6 months postreconstruction. Range of movement of each knee joint achieved at least 90 degrees of active flexion. We have shown that large segmental traumatic defects of the femur can be successfully reconstr...

Injury Extra, 2009

Introduction: Fractures of the distal radius are among the most common skeletal injuries. However... more Introduction: Fractures of the distal radius are among the most common skeletal injuries. However, there remains controversy as to how they are best treated. Though there is literature to suggest that operative interventions can enhance the radiological picture, there is no definitive evidence that surgery improves the patient's functional outcome. Outcome assessments are an important method of evaluating the efficacy of a procedure. They allow the surgeon to distinguish between modalities of treatment, but there are no clear guidelines as to which one should be used. Methods: Over a 1-year period, 794 patients were coded as having sustained wrist fractures by the hospital accident and emergency department. Of the cohort, 258 X-rays were identified as distal radius fractures configurations, which were classified according to AO. Management included casting, K-wires or a volar plating system. All patients were sent the validated Patient Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires for completion. Results: The functional assessments were administered between 330 and 690 days after the original fracture. The mean age of the patients was 63 years. After accounting for injury severity using the AO classification, no significant difference in outcome was found between the three treatment options (p = 0.86). The questionnaires were found to correlate well, with a Pearson's correlation coefficient between the PRWE and DASH scores of 0.88. Discussion: Surgical intervention does not necessarily improve the patient's functional result. Either validated questionnaire is appropriate to use for distal radius fractures, with little indication for both together in the future.

Connective Tissue Research, 2007

Growth factors are important in the development, maintenance and repair of cartilage. The princip... more Growth factors are important in the development, maintenance and repair of cartilage. The principal aim of this study was to test the capacity of three growth factors with established roles in cartilage, namely insulin-like growth factor (IGF)-1, fibroblast growth factor (FGF) and transforming growth factor (TGF)-beta 1, to alter intracellular reactive oxygen species (ROS) levels. Explants of articular cartilage from young, mature, and aged rats were pretreated with IGF-1, FGF, or TGF-beta 1 and intracellular ROS levels were quantified using the free radical sensing probe dihydrorhodamine 123 (DHR 123), confocal microscopy, and densitometric image analysis. Viability of chondrocytes following ROS stress and growth factor treatment was assessed using the live/dead cytotoxicity assay, and the activities of the antioxidant enzymes--catalase (CAT), total superoxide dismutase (SOD), and glutathione peroxidase (GPX)--were measured spectrophotometrically by decay of the substrate from the reaction mixture. The effect of IGF-1 on ROS levels in cultured human chondrocytes also was examined. In rat cartilage, FGF did not significantly affect ROS levels or antioxidant enzyme activity in any age group. TGF-beta1 significantly increased cellular ROS levels in mature and old cartilage whereas in marked contrast, IGF-1 significantly and age-dependently reduced ROS levels. IGF-1 also had a potent antioxidant effect on cultured human chondrocytes. Pretreatment of rat cartilage with IGF-1 significantly enhanced the activity of GPX, without altering the activity of SOD or CAT, and protected chondrocytes against ROS-induced cell death. TGF-beta 1 had no significant effect on the activity of the antioxidant enzymes. Despite promoting ROS production, TGF-beta 1 was not cytotoxic. We concluded that TGF-beta 1 exhibits an acute pro-oxidant effect in cartilage that is not cytotoxic, suggesting a role in physiological cell signalling. In marked contrast, IGF-1 is a potent antioxidant in mature and aged rat and human chondrocytes, protecting cells against ROS-induced cell death probably through the enhancement of the activity of the antioxidant enzyme GPX.

British Journal of Oral and Maxillofacial Surgery, 2011

The transverse rectus abdominis musculocutaneous (TRAM) flap based on the deep inferior epigastri... more The transverse rectus abdominis musculocutaneous (TRAM) flap based on the deep inferior epigastric artery is useful in head and neck reconstruction as it provides substantial skin and soft tissue cover, and allows volume to be replaced in large defects. A major advantage is the anatomical reliability of the deep inferior epigastric pedicle. We report a case in which neither rectus abdominis muscles had a blood supply from the deep inferior epigastric artery, which necessitated a change in the planned reconstruction. We review variations in the anatomical course of the artery and, although rare, stress the importance of reconstructive surgeons being aware of such variations.