St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns

Introduction

This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines.

Method

A prospective cohort study was undertaken in all patients who underwent surgical (n = 1429) or non-operative (n = 191) management during the UK COVID-19 pandemic peak (April–May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, n = 729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n = 100) or waiting list (control group, n = 250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group).

Results

Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups (p = 0.236).

Conclusion

We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.

Medium thickness plantar skin graft for the management of digital and palmar flexion contractures

The fundamental principle of reconstruction is to replace the lost tissue with similar tissue. Because of the unique similarities in characteristics, plantar skin is an excellent donor area for skin grafting for the palmar aspect of the digits and hand. It provides an ideal color and texture match and long durability with an inconspicuous donor site. However, the use of plantar skin in management of digital and palmar defects is only rarely reported in the literature. Doubts were raised on donor site healing and incidence of recurrence of contracture. There are reports of using full thickness skin graft and dermal grafting from planta in similar cases. We have used medium thickness split grafts from sole of foot in correcting 262 cases of flexion contracture of digits and palms. Thick split skin grafts, full thickness grafts, local flaps and Z plasties were used in numbers of other cases. The technique of plantar skin grafts, application and results with reference to take of graft, quality of skin, donor area healing and recurrence are discussed and compared with available methods and studies.

Ecosystem studies on upper region of Ganga River, India

A multi-disciplinary research programme on the Ganga River Ecosystem was launched by the Government of India in 1983 to collect information on its attributes. Monitoring of the initial 509 km unpolluted and unmonitored region of the river falling in partly mountainous and partly upper plain stretches for two years revealed good water quality. The Song River (a tributary) catchment, a victim of extensive mining activity in the past, was found to add maximum mineral load. The Bhagirathi River was found to carry maximum suspended solid load. Organic pollution was low throughout, occasionally showing seasonal and local peaks. The river exhibited a high oxidative state with pH falling in a slightly alkaline range and nutrient levels being very low.Diatoms formed a major part of the encountered genera of phytoplankton. Zooplankton were mainly represented by protozoans. Saprophytic bacteria underwent large spatial and temporal fluctuations. Coliforms exhibited an increasing trend with downstream river distance. The source of pollution could not be specifically characterized from an FC/FS ratio. Only one sample tested positive for enteric virus. The forms of benthic macroinvertebrates indicated a clean stream environment. It was observed that diversity indices, together with evenness and community comparison, could provide a promising approach to determine the state of the community.Eight heavy metals investigated, Cu, Zn, Fe, Cd, Mn, Pb, Ni and Co, were found to be present in the river water and bed sediments. The prominent mode of metal transport was found to be via the suspended load. The concentration of dissolved metals was found within WHO permissible limits. The heavy metal status of the Ganga River was compared with other rivers of the world. Sorptive properties of sediments were found to be similar to the general sorptive behaviour of the clays. Laboratory studies exhibited reasonable short t 90 values for coliform survival in Ganga water. Faecal streptococcus survived longer.

Transverse lumbar flap for sacral bed sores

Over the last 30 months, we covered all the 21 cases of sacral pressure sores admitted to our section with the transverse lumbar flap. All the flaps survived. The rationale of the flap design, its technique, and complications are described. The advantages and the drawbacks of the flap are also described. One of the major principles of bed-sore flaps, i.e., that the flap should be as large as possible, need not be adhered to.