Functional outcomes scores such as the LEFS demonstrate that patients can obtain an adequate level of functionality for independent community activity after free tissue transfer, although functional improvement diminishes with age.

SUMMARY Background Post-mastectomy pain syndrome (PMPS) is a surgical complication of breast surgery characterized by chronic neuropathic pain. The development of PMPS is multifactorial and research on its prevention is limited. The objective of this systematic review is to synthesize the existing evidence on interventions for lowering the incidence of persistent neuropathic pain after breast surgery. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the electronic databases of MEDLINE, Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov using a combination of database-specific controlled vocabulary and keyword searches. Two reviewers independently screened all unique records. Publications on chronic (>3-month duration) pain after breast cancer-related surgery were included. Studies were classified by modality. Results Our literature search yielded 7092 articles after deduplication. We identified 45 studies that met final inclusion criteria for analysis, including 37 randomized-controlled trials. These studies revealed seven major intervention modalities for prevention of PMPS: physical therapy, mindfulness-based cognitive therapy, oral medications, surgical intervention, anesthesia, nerve blocks, and topical medication therapy. Conclusion High-quality data on preventative techniques for PMPS are required to inform decisions for breast cancer survivors. We present a comprehensive assessment of the modalities available that can help guide breast and reconstructive surgeons employ effective strategies to lower the incidence and severity of PMPS. Our review supports the use of multimodal care involving both a peripherally targeted treatment and centrally acting medication to prevent the development of PMPS.

Background Although many cricket-playing nations have conducted research on bowling volume (BV) and injury risk, this relationship amongst international South African pace bowlers is yet to be investigated. Environmental, socio-economic and training strategy differences warrant similar research in a South African context. The purpose of this preliminary study was to establish whether South African pace bowlers have similar BV and injury associates compared to other elite fast bowlers. Methods This study was a prospective, observational, cohort study that monitored match and training BV and injuries amongst pace bowlers playing for the South African national team between April 2017 and April 2019. A sample of convenience that included 14 bowlers was selected. Bowling volume was quantified as the number of deliveries bowled during training and competition. Acute-, chronic- and acute:chronic BV ratios were independently modelled as association variables. Results There were 39 injuries with the most being to the lumbar spine (25.64%). Moderate-to-low and a moderate-to-high acute:chronic bowling load ratios were associated with a lower risk of injury. Chronic bowling load was associated with injury (z  =  2.82, p  =  0.01). A low acute workload, low chronic workload, moderate-high chronic workload and moderate-low acute:chronic ratio were also associated with an increased risk of injury. Conclusion These findings confirm that there appears to be a dose–response effect between training BV and the likelihood of an injury occurring with a moderate-to-low and a moderate-to-high BV ratio being optimal. Considering the small sample size, the findings should be interpreted with caution.

Background: Over the past 3 decades, advances in transplant surgery have allowed life-saving renewal of solid organ function. Many of these patients are predisposed to the development of lower extremity wounds. There is a paucity of data describing treatment and outcomes of this complex patient population. The purpose of this study is to examine the surgical outcomes of these patients and overall limb salvage rates in a tertiary care center with a multi-disciplinary team focused on limb salvage. Methods: Medical records were reviewed for all patients with a foot wound and functioning solid organ transplant who received surgery (including debridement or toe/foot/limb amputation) at our institution from 2010-2017. Results: We identified 59 patients with lower extremity wounds and a prior transplant, 40 with a kidney transplant, 13 with combined kidney-pancreas transplant, and 6 with a liver transplant. The average solid organ transplant patient received 6.5 (±4.8) procedures during the follow-up period (46mos, 6.8-149.4). There were 32 patients (54.2%) who required toe amputations, 15/32 (46.9%) of these healed, 14 (43.8%) required a midfoot amputation, and 8 (25%) progressed to a below-knee amputation (BKA). Of patients with hind foot wounds 11/15 (73.3%) required calcanectomy, of these 7/11 (63.6%) progressed to a BKA. Overall, there were 19/59 (32.2%) patients who required below knee amputations, including the 15 which progressed from lesser procedures; two of the patients requiring BKA progressed to an above knee amputation. Conclusions: This retrospective study highlights the morbidity associated with foot ulceration in the immunosuppressed patient with an overall BKA rate of 32.2%. Solid organ transplant patients who develop lower extremity wounds require a high level of surgical care. A large proportion of these patients will eventually require a major lower extremity amputation. Further investigation is needed to develop better strategies for lower extremity salvage in the immunosuppressed patient. Disclosure E. Walters: None. K.M. Termanini: None. B.T. Jackson: None. T.M. Chadab: None. J. Wang: None. P.J. Kim: Consultant; Self; Acelity, Integra LifeSciences. K. Evans: None.