Chrysis Sofianos

Background: Timely admission to a specialised burn unit is considered crucial for optimising outcomes in burn patients. However, the impact of delayed admission on hospital length of stay and clinical outcomes remains unclear, particularly in resource-constrained settings such as South Africa. This retrospective study aimed to determine whether admission to a burn unit more than 24 h after injury was associated with increased length of stay, sepsis, or mortality. Methods: A retrospective case-audit study was conducted at the Chris Hani Baragwanath Academic Hospital Adult Burn Unit, Johannesburg, from January 2018 to December 2022. Patients were categorised into early (≤24 h) and delayed (>24 h) admission groups. The primary outcome was length of stay; secondary outcomes included sepsis incidence and in-hospital mortality. Results: A total of 123 files were analysed; 71 (58%) were admitted within 24 h. The median length of stay was 14 days, with no statistical difference between the two groups (p = 0.7). The overall mortality rate was 13%, with 68% occurring in the early admission group. Sepsis occurred in 27% of patients. Multivariate analysis revealed that early admission was independently associated with longer length of stay. Conclusions: In this single-centre retrospective case note audit with a limited sample size and significant risk of selection bias, delayed admission to a burn unit was not associated with increased length of stay, mortality, or sepsis. However, these findings should be considered preliminary and require confirmation in larger, prospective studies. The higher rate of surgical intervention in the delayed admission group warrants further investigation.

Background: Since the early postapartheid period, the South African government has implemented policies to strengthen the public health system. However, structural challenges continue to affect registrar training in plastic surgery. Methods: A prospective, descriptive survey was distributed to approximately 180 plastic surgery trainees and consultants across South Africa. Thirty-seven responses were received. The questionnaire collected demographic data and opinions on training content, teaching quality, research support, mentorship, and proposed reforms. Results: The majority of respondents believe the current 5-year training period is appropriate but highlighted significant gaps in aesthetic, craniofacial, oculoplastic, and nonsurgical rejuvenation training. There was strong support for private practice rotations, a shift toward competency-based curricula, and improved mentorship and research support. Journal clubs and interuniversity meetings were rated poorly, whereas short courses and operative lists were highly valued. Consultant supervision and teaching time were widely seen as inadequate. Conclusions: Respondents identified both strengths and weaknesses in the current training system. Key strengths included the structured program length and foundational training in skin cancer surgery. However, improvements are needed in subspecialty exposure, consultant-led teaching, and academic mentorship. There was broad support for integrating competency-based training, private sector exposure, and enhanced research infrastructure to improve trainee preparedness and program quality.

Background: Premature sagittal suture fusion causes scaphocephaly, the most prevalent type of nonsyndromic craniosynostosis. There is no consensus on the optimal surgical approach, despite several corrective techniques having been described. The results of a standardized open cranial vault remodeling (CVR) technique with simplified osteotomy planning, intended to address the phenotypic characteristics of sagittal synostosis, are presented in this study. Methods: Between 2013 and 2023, 22 consecutive patients with moderate-to-severe scaphocephaly who had total CVR using a reproducible technique were retrospectively reviewed. The cephalic index (CI), complications, operative parameters, and patient demographics were reviewed. The method includes occipital reshaping to restore cranial contour, posterior repositioning of a broad sagittal strip, and biparietal widening through outward fractures and triangular osteotomies. Findings: A total of 59% of patients were male, and the mean age at surgery was 8.8 months (range: 4–13 mo). A total of 91% of patients needed a transfusion (mean volume: 418 mL), and the average operating time was 312.8 minutes. Postoperatively, all patients were managed in the intensive care unit for a mean duration of 66 hours (range: 48–93 h). No significant complications were noted. Two instances of minor wound separation were treated conservatively. There was no evidence of wire extrusion, hemorrhage, or bone graft loss. All patients showed subjective improvement in cranial morphology, supported by a significant improvement in the mean preoperative CI of 62 at follow-up (mean: 35 mo; range: 7–77 mo). Conclusions: The proposed CVR method is safe and demonstrates improvement at long-term follow-up. It accomplishes posterior height correction and long-lasting biparietal widening without causing issues with the hardware. This method provides a dependable option for sagittal synostosis correction within the surgical spectrum.

Background: The main purpose of a medical facility is to improve the welfare of patients, and user satisfaction is one of its primary goals. This study aimed to identify variables influencing patient satisfaction at the Plastic Surgery Outpatient Department of Chris Hani Baragwanath Academic Hospital, Gauteng, South Africa. By identifying factors affecting patient satisfaction, the services provided to patients may be improved. Methods: A questionnaire was compiled focusing on patients over 18 years of age and using a Likert scale to measure factors influencing patients’ satisfaction with the services received. Descriptive statistics were applied. Results: A total of 142 participants, 69% of whom were under age 40 and 52.8% were male, were recruited using a systematic sampling technique. In 78% of cases, this was the patient’s first visit to the clinic. The results revealed that the patients were not satisfied with the ease of appointment scheduling and waiting times. A high level of satisfaction was reported for both nursing staff and doctors, aside from a lack of clear and prominent display of name badges. Overall satisfaction was at the “satisfied” level, and no participants reported lower than neutral feelings. The CSAT score was 79.5%, which is considered “good” for healthcare. The participant’s level of education was significant in multiple items; those with the lowest education reported higher overall satisfaction. A model produced by regression analysis was found to be strongly significant statistically. Discussion: Batho Pele principles in South Africa provide a framework for consulting with service consumers, ascertaining their happiness, and identifying methods to enhance their experience. According to this survey, people are happy with the human part of the services received, although areas such as scheduling appointments and the physical surroundings still need much work. Conclusion: These aspects of treatment are occasionally disregarded in a medical organisation with insufficient finances. Developing these areas can help turn patients into devoted patrons of a healthcare facility. An effective strategy to boost customer satisfaction has been suggested to enhance service quality and, especially in South Africa, conform to Batho Pele service standards.

Background: Orofacial clefts represent the most common craniofacial malformation diagnosed at birth and may be divided into isolated cleft lip (CL), cleft lip and palate (CL/P), or isolated cleft palate (CP). The causes of orofacial clefts have long been understood to be multifactorial; however, research into the genetic and environmental factors underpinning these disorders in African populations is scant. Seasonal variation in the occurrence of orofacial clefts was investigated. Seasonal variation is defined as differences due to periodic, temporal, and external influences, namely the particular time or season of the year. Methods: The study design is a retrospective record review and sampled patients presenting to the Cleft Clinic at Charlotte Maxeke Johannesburg Academic Hospital during the time period October 2000 to October 2015. Ethical approval was obtained. Information recorded included patient demographics (date of birth and gender), diagnosis and laterality of the cleft. Results: This study includes 512 infants. This study shows seasonal variation in the incidence of orofacial clefts limited to patients with both a CL/P. There was no significant seasonal variation observed in isolated CL or CP and laterality of the cleft. Significant seasonal variation was observed only in those born in winter versus summer, with more children born with a CL/P in winter months. Conclusion: Seasonal (or temporal) variation indicates a distinct environmental influence on the formation of orofacial clefts in utero, more specifically in pregnancies with the first trimester during spring. Several reasons have been advanced and include sunlight exposure and vitamin D levels, weight gain, and maternal obesity. More study is required to further elucidate these reasons.

The current case report will focus on the key factors that influence the revascularization of a hand. Emphasis will be placed on microsurgery, timing factors and intraoperative factors as well as postoperative factors. The principles of microsurgery in the paediatric patient compared to that of the adult are still the same. Paediatric patients do pose an advantage of having no/ fewer comorbidities. It has been shown they have a high capacity of regeneration; however paediatric patients do come with their challenges such as the size and diameter of the vessels. This case presentation will focus on a 6-year-old male child’s dominant hand revascularization, from onset of injury to rehabilitation phase. Timing is crucial, as if not picked up early enough it is associated with morbidity and mortality. We also look at the successful outcome of the revascularization surgery in the paediatric patient.

A 24-year-old womanpresented with ameloblastic fibrosarcoma arising from ameloblastic fibroma. The delayed presentation accounted for the extensive destruction of the mandible and complete occlusion of her oral cavity. This resulted in an inability to eat and maintain oral hygiene. A multidisciplinary team management approach involved nutritional optimisation, segmental mandibulectomy, reconstruction with a reconstructive plate and a free anterolateral thigh flap to line the the floor of mouth. Functional and aesthetic outcome was acceptable, and the patient is planned for secondary free fibular flap bony reconstruction.

Laparoscopic sleeve gastrectomy (LSG) has gained popularity over the years as a standalone procedure. In 2014, it was the most rapidly growing bariatric procedure. The aim of this study was to describe the outcomes of LSG at a single bariatric unit in Johannesburg, South Africa, using the Bariatric Analysis and Reporting Outcome System (BAROS) standardised scoring. A retrospective record review and analysis was carried out using data collected from patients who had LSGs. The information obtained included patient demographics, comorbidities, preoperative weight and height, operative technique, time and complications, postoperative gastrografin swallow results, hospital stay, and weight at 6 months postoperatively. The percentage of excess body mass index (BMI) loss (%EBMIL) was calculated at 6 months, and included in the BAROS questionnaire completed by the patients at the 6-month follow-up visit. Statistical significance was set at p < 0.05. A total of 103 patients were included in the study; of these, 85.4% were female and 14.6% were male. The mean preoperative BMI was 42.1 kg/m²; additionally, 77.7% of the patients in the study had comorbidities prior to the procedure. The mean operative time was 104.3 min, with a mean hospital stay of 2.5 days. No mortalities occurred, and a complication rate of 7.7% was encountered. At the 6-month follow-up, the mean %EBMIL was 65%. When followed up at 6 months, all 103 patients demonstrated no failures according to the BAROS assessment. It was found that 96.1% had good, very good or excellent outcomes. In total, 9.7% of the patients had an excellent outcome. LSG was shown to produce an adequate %EBMIL loss at 6 months, resulting in a significant improvement in the quality of life (QoL), coupled with good BAROS outcomes. The results of this research are comparable to other studies of LSGs, and the low complication rate supports the use of the procedure and accounts for no observed mortality.

Trichilemmal carcinoma (TC) is described as a very rare cancer of the skin adnexa.^{1 2} Ninety per cent of the lesions present on the scalp. Prognostic factors in TC are limited to lymph node status and surgical margins, with no statistical significance observed for age or gender of the patient, size of tumour or locoregional recurrence. We present a 46-year-old black patient who developed TC during treatment for breast cancer. Postoperative histology of the scalp lesion excision confirmed no involved margins. At the three monthly appointment, the patient was reviewed and multiple, new scalp lesions were noted. A CT scan of the head, neck found multiple lesions on the scalp, limited to the soft tissue, not involving the outer table of the skull. There was bilateral invasion of the parotid glands. To the best of our knowledge, no syndromes or associations between breast cancer and adnexal skin tumours exist.

Pathological findings in reduction mammoplasty specimens: A South African perspective