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Boyce DE. Re: Beecher SM, Kennedy S, Joyce KM. A novel technique in the management of Type IV flexor digitorum profundus injuries. J Hand Surg Eur. 2022, 47: 1169-71. J Hand Surg Eur Vol 2023:17531934231155821. [PMID: 36896494 DOI: 10.1177/17531934231155821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Li Z, Leong S, Malik M, Ibrahim N, Sin-Hidge C, Clancy R, Dobbs TD, Jessop ZM, Duncan RT, Hemington-Gorse S, Tickunas T, Yarrow J, Drew PJ, Boyce DE, Whitaker IS. Rapid redesign and effect on clinical workload of a supra-regional burns and plastic surgery service during the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2021; 75:831-839. [PMID: 34740568 PMCID: PMC8496921 DOI: 10.1016/j.bjps.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/08/2021] [Accepted: 09/19/2021] [Indexed: 11/27/2022]
Abstract
Introduction In March 2020, South Wales experienced the most significant COVID-19 outbreak in the UK outside of London. We share our experience of the rapid redesign and subsequent change in activity in one of the busiest supra-regional burns and plastic surgery services in the UK. Methods A time-matched retrospective service evaluation was completed for a 7-week “COVID-19” study period and the equivalent weeks in 2018 and 2019. The primary aim of this study was to evaluate plastic surgery theatre use and the impact of service redesign. Comparison between study periods was tested for statistical significance using two-tailed t-tests. Results Operation numbers reduced by 64% and total operating time by 70%. General anaesthetic cases reduced from 41% to 7% (p<0.0001), and surgery was mainly carried out in ringfenced daycase theatres. Emergency surgery decreased by 84% and elective surgery by 46%. Cancer surgery as a proportion of total elective operating increased from 51% to 96% (p<0.0001). The absolute number of cancer-related surgeries undertaken was maintained despite the pandemic. Conclusion Rapid development of COVID-19 SOPs minimised inpatient admissions. There was a significant decrease in operating while maintaining emergency and cancer surgery. Our ringfenced local anaesthetic Plastic Surgery Treatment Centre was essential in delivering a service. COVID-19 acted as a catalyst for service innovations and the uptake of activities such as telemedicine, virtual MDTs, and online webinars. Our experiences support the need for a core burns and plastic service during a pandemic, and show that the service can be effectively redesigned at speed.
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Affiliation(s)
- Zoe Li
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Samantha Leong
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Mohammad Malik
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Nader Ibrahim
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, UK
| | - Claire Sin-Hidge
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Rachel Clancy
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Thomas D Dobbs
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, UK
| | - Zita M Jessop
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, UK
| | - Robert T Duncan
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Sarah Hemington-Gorse
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Tomas Tickunas
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Jeremy Yarrow
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Peter J Drew
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Dean E Boyce
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | - Iain S Whitaker
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK; Reconstructive Surgery & Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, UK.
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Tonkin MA, Boyce DE, Fleming PP, Filan SL, Vigna N. The results of pollicization for congenital thumb hypoplasia. J Hand Surg Eur Vol 2015; 40:620-4. [PMID: 24859992 DOI: 10.1177/1753193414535177] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/11/2014] [Indexed: 02/03/2023]
Abstract
We assessed pollicizations performed by one surgeon; compared function of the pollicized digit in patients with and without forearm/wrist anomalies; and determined if hand function changed with age. A total of 42 hands were assessed an average of 5.7 years post-operatively, 21 with a forearm/wrist anomaly (Group 1) and 21 without (Group 2). Fourteen patients with 16 pollicizations were assessed on two occasions 3.5 years apart. Carpometacarpal joint motion was near normal in both groups (decreased retropulsion in Group 1). Metacarpophalangeal and interphalangeal joint flexion, grip, thumb lateral and tip pinch strengths, and Jebsen timed test were superior in Group 2. Subjective assessment by patients/parents found 72% excellent/good results for function and 94% for appearance. Doctor excellent/good assessments were 60% and 70%, respectively. Forearm/wrist anomalies significantly compromised results but are not a contraindication for pollicization. Strength and Jebsen timed test measurements improved at the second assessment of 16 thumbs, but this was consistent with age-related improvement. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M A Tonkin
- Department of Hand Surgery & Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - D E Boyce
- Department of Hand Surgery & Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - P P Fleming
- Department of Hand Surgery & Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - S L Filan
- Department of Hand Surgery & Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
| | - N Vigna
- Department of Hand Surgery & Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
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George S, Boyce DE. The management of common peroneal nerve injury: Predictors of outcome following repair–the rule of 12's. J Plast Reconstr Aesthet Surg 2014. [DOI: 10.1016/j.bjps.2014.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, Dickson WA, Whitaker IS. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. PLoS One 2014; 9:e95042. [PMID: 24751699 PMCID: PMC3994014 DOI: 10.1371/journal.pone.0095042] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.
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Affiliation(s)
- Ernest A. Azzopardi
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Elayne Azzopardi
- Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom
| | - Liberato Camilleri
- Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta
| | - Jorge Villapalos
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - Dean E. Boyce
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Peter Dziewulski
- St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - William A. Dickson
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
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Abstract
This article evaluates the outcome of 42 consecutive zone 1 flexor tendon injuries treated by using micro bone anchors during the period 2003-2008. Patients were rehabilitated using the modified Belfast Regime. The range of motion at the distal interphalangeal joint was assessed using Moiemen's classification. A total of 56% of patients achieved excellent or good results for range of motion at the distal interphalangeal joint and 23% had a poor outcome. The mean distal interphalangeal joint and proximal interphalangeal joint range of motion were 48° and 96°, respectively. A total of 94% of patients returned back to work by 12 weeks. One patient sustained a tendon rupture and one developed osteomyelitis. The mean QuickDASH score was 13.5 and 81% of patients were satisfied with their outcomes. This is the largest clinical study on the use of bone anchors for zone 1 tendon injuries. Our study demonstrated a low rate of complications and outcomes that compare favourably with other published techniques.
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Affiliation(s)
- S Huq
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Abstract
Dupuytren's disease is a common, costly and recurrent health issue. This review compares Clostridium histolyticum collagenase with current operative treatments. Collagenase management is an effective non-surgical alternative associated with lower risks of serious adverse events, but higher incidence of non-serious adverse events.
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Affiliation(s)
- Ernest Azzopardi
- Hand Surgery Unit, Welsh Centre for Burns and Plastic Surgery, Morrison Hospital, Swansea SA6 6NL, UK
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Azzopardi EA, Boyce DE, Thomas DW, Dickson WA. Colistin in burn intensive care: back to the future? Burns 2012; 39:7-15. [PMID: 22871554 DOI: 10.1016/j.burns.2012.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/19/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
Abstract
Colistin is a venerable antibiotic whose fortunes have been revived by its excellent activity, the diminishing output of novel clinically effective antibiotics and the increasing importance of MDR infection in burn surgery, both in the civilian and military arenas. This review synthesizes current evidence on the usage of colistin in burn surgery including the structure-activity relationship; dosing, pharmacokinetics/pharmacodynamic (PK/PD), analytic methods, resistance and current research efforts into the redevelopment of this antibiotic, to distil recommendations for future research and clinical efficacy.
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Affiliation(s)
- Ernest A Azzopardi
- Wound Biology Group, Tissue Engineering and Reparative Dentistry, School of Dentistry, Cardiff University, Heath Park, Cardiff, CF144XY, UK.
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Marsden NJ, Whitaker IS, Boyce DE. The oldest reported mirror hand? The curse of the coal-house frog! Ann R Coll Surg Engl 2012; 94:e149-51. [PMID: 22613283 DOI: 10.1308/003588412x13171221589577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Despite being one of the rarest congenital upper limb abnormalities, a wide spectrum of the typical mirror hand has been described in the literature. We report a very interesting case of a new variant of mirror hand presenting in a 78-year-old man. The unique features of the case include the age at diagnosis, the anatomical features present and the acquired function despite no form of reconstructive surgery.
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Affiliation(s)
- N J Marsden
- Abertawe Bro Morgannwg University Health Board, UK.
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Naderi N, Maw K, Thomas M, Boyce DE, Shokrollahi K. A quick and effective method of limb preparation with health, safety and efficiency benefits. Ann R Coll Surg Engl 2012; 94:83-6. [PMID: 22391363 DOI: 10.1308/003588412x13171221500420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed 'static' posture for several minutes. This is hazardous to theatre staff. Furthermore, 'painting' the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the 'sterile bag' preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists. METHODS We monitored the duration of PLP in 20 patients using the 'sterile bag' technique compared to 20 patients using a conventional 'painting' method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery. RESULTS The mean duration of the 'sterile bag' PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken. CONCLUSIONS The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.
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Affiliation(s)
- N Naderi
- Welsh Centre for Burns and Plastic Surgery, Swansea, UK
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Lohana P, Sharma H, Hemington-Gorse S, Boyce DE. Survival of skin graft in mycosis fungoides - a solution for a management dilemma. Ann R Coll Surg Engl 2007; 89:W13-4. [PMID: 17958997 DOI: 10.1308/147870807x227809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a case where the surgical defect caused by Fournier's gangrene in a patient with mycosis fungoides was managed in a novel way.
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Affiliation(s)
- Parkash Lohana
- The Welsh Centre for Burns and Plastics Surgery, Morriston Hospital, Swansea, UK.
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Whitaker IS, Mason L, Boyce DE, Cooper MACS. An analysis of 1361 aesthetic procedures from 2000 to 2005 in a large regional plastic surgery unit: implications for cosmetic surgery training. J Plast Reconstr Aesthet Surg 2007; 60:437-9. [PMID: 17349602 DOI: 10.1016/j.bjps.2006.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 11/07/2006] [Indexed: 10/23/2022]
Abstract
One of the challenges facing our profession is the adequate training of plastic surgeons in the subspeciality of aesthetic surgery, in addition to covering the rest of the large curriculum. The UK's Chief Medical Officer, Professor Sir Liam Donaldson, has recently called for better training for doctors, better information for patients, and a touger regulatory structure for private cosmetic surgery. In this study, we show that the training of cosmetic procedures in our unit has risen steadily over the 6 year period studied. As part of our committment to improving training, our unit has recently organised a 3 month block soely dedicated to aesthetic surgery, allowing increasing exposure to cosmetic clinics and theatre sessions. It is clear that as a group, we must continue to develop robust training schemes to produce plastic surgeons able to cope with the demands of 21st Century healthcare, and ensure that the public does not fall prey to practitioners in unregulated clinics.
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Affiliation(s)
- Iain S Whitaker
- Welsh Centre for Burns and Plastic Surgery, The Morriston Hospital, Swansea, UK.
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Boyce DE, Shokrollahi K. ABC of wound healing:Reconstructive surgery. Assoc Med J 2006. [DOI: 10.1136/sbmj.0611409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Dean E Boyce
- Welsh Centre for Plastic Surgery, Morriston Hospital, Swansea
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Affiliation(s)
- Alex Benson
- Mersey Regional Plastic Surgery Unit, Whiston Hospital, Liverpool
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Abstract
A previously undescribed lesion of Dupuytren's disease is presented. An oblique cord coursed parallel to the oblique retinacular ligament of Landsmeer, but inserted proximal to the proximal interphalangeal joint, tethering the central slip and radial lateral band across the intervening transverse retinacular ligament. Contraction of this cord caused a rigid swan-neck deformity. Excision of the cord resulted in complete resolution of the deformity and a full range of motion in the affected digit.
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Affiliation(s)
- D E Boyce
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW 2065, Sydney, Australia
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Kannan RY, Boyce DE, Peart FC. Surface marking the vascular pedicle of scapular flaps: "scapular triangle". Plast Reconstr Surg 2003; 112:1196-7. [PMID: 12973264 DOI: 10.1097/01.prs.0000077244.59390.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boyce DE. Dermal cellular inflammation in burns: an insight into the function of dermal microvascular anatomy. Burns 2002; 28:206; author reply 207. [PMID: 11900951 DOI: 10.1016/s0305-4179(01)00106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The aim of this study was to investigate the contribution of lymphocytes and macrophages to keloid scarring by morphologically characterising inflammatory cell subpopulations in keloid scars in comparison with normal skin. We took 3mm punch biopsies from the anterior forearms of eight normal healthy volunteers. Eight keloid scars were excised using an intralesional technique. All tissue was snap frozen in liquid nitrogen and serial sections were stained with a panel of anti-inflammatory cell monoclonal antibodies. The numbers of macrophages and lymphocytes and the proportions of the subpopulations were compared. Higher numbers of both macrophages and lymphocytes were found in keloid dermis (P=0.01 and P=0.02, respectively (Mann-Whitney U -test)). There was no significant increase in the expression of the lymphocyte-activation markers, CD25 and CD27. However, there was a significantly higher CD4(+):CD8(+)(Th:Ts) ratio (P= 0.046) in keloid tissue. This suggests that an imbalance in these inflammatory cell subpopulations may contribute to keloid scarring in man.
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Affiliation(s)
- D E Boyce
- Department of Plastic Surgery, Diana, Princess of Wales Children's Hospital, Birmingham, UK
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Abstract
Recurrent subdermal scar tethering is a difficult management problem in areas of high tissue mobility. We describe a novel solution to this clinical problem, which involves instilling the anti-fibrotic gel ADCON-T/N in the plane between the skin and the underlying structures. We present our results in three difficult clinical situations where excellent results have been achieved using this method.
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Affiliation(s)
- D E Boyce
- West Midlands Regional Plastic and Jaw Surgery Unit, Wordsley Hospital, Stourbridge, West Midlands, UK
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Abstract
BACKGROUND Animal experimental data indicate a requirement for functionally active T lymphocytes to allow optimal healing of dermal wounds. Little evidence exists to confirm that this is the case in humans. Lymphocyte involvement in regulation of healing is probably mediated by release of secreted cytokines/growth factors, and we hypothesize that the cytokine profile requirement will be modulated as healing progresses. OBJECTIVES As this is likely to be reflected in lymphocyte subset changes over the course of normal healing, we investigated the immunophenotype of lymphocyte subpopulations during wound healing. METHODS Sequential biopsies were taken over 42 days from the margin of 12 wounds healing by secondary intention after pilonidal sinus excision. Serial biopsy sections were analysed by immunohistochemistry using lymphocyte-specific monoclonal antibodies, and lymphocytes were counted microscopically. RESULTS Within 42 days, the mean decrease in wound volume was 87.5%. This was accompanied by significant changes in the wound margin lymphocyte population. Total numbers (mean +/- SEM) of T lymphocytes decreased from 36.8 +/- 9.8 cells per field at inclusion in the study to 25.9 +/- 3.0 immediately prior to wound closure, with a concomitant increase in B lymphocytes from 1 +/- 0.4 to 9.5 +/- 3.6 cells per field. The CD4/CD8 T-lymphocyte ratio fell from an initial level of 3.6 +/- 0.3 to 2.1 +/- 0.3 (mean +/- SEM) prior to closure. CONCLUSIONS These data indicate that human wound-associated lymphocyte populations are modulated during healing; the increase in numbers of CD8+ T-suppressor lymphocytes is in accordance with previous animal data, indicating a role for these cells in downregulating healing as the wound closes. This study also documents an associated increase in B lymphocytes and healing of human wounds, with an as yet undefined role.
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Affiliation(s)
- D E Boyce
- West Midlands Regional Plastic, Cardiff, UK
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Ciampolini J, Boyce DE, Shandall AA. Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England. Ann R Coll Surg Engl 1998; 80:335-8. [PMID: 9849333 PMCID: PMC2503110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
This study investigated the impact of the guidelines of The Royal College of Surgeons of England on the practice of hernia surgery in Wales. This was assessed by means of a postal survey to all consultant general surgeons in Wales in 1996-1997. The areas covered were: awareness of the guidelines of The Royal College of Surgeons of England and the impact of such guidelines on their practice, attendance at hernia courses, operative technique, materials used for repair and skin suture, proportion of day case hernias, length of inpatient stay, thromboembolic (TE) prophylaxis and postoperative advice to patients with regard to light work, heavy work and sport. In all, 79 replies were received (85%). Almost all the surgeons had read the guidelines; this changed the practice of 20% of respondents but did not in 32%. A further 48% did not answer the question. In contrast with our 1993 survey results, in Wales there is now a uniform surgical management of adult inguinal hernias: the most common operation is the Liechtenstein, with monofilament non-absorbable suture to secure the mesh, followed by the Shouldice repair. The Bassini and inguinal darn operations are becoming much less common and none now uses braided or absorbable sutures for the repair. Skin closure is still rather variable, with only 58% of respondents adhering to the recommended absorbable subcuticular suture. Postoperative advice is now uniform and in accordance with the guidelines. A trend towards more TE prophylaxis and more day case hernia surgery is also seen.
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Boyce DE. Non-Hodgkins lymphoma masquerading as a chronic venous leg ulcer. Br J Plast Surg 1998; 51:487. [PMID: 9849377 DOI: 10.1016/s0007-1226(98)80039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Boyce DE, Harding KG. Chronic leg ulcers: beware the 'wolf in sheep's clothing!'. Ann R Coll Surg Engl 1997; 79:381-2. [PMID: 9326133 PMCID: PMC2503044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- D E Boyce
- University Department of Surgery, University of Wales College of Medicine, Cardiff
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Boyce DE, Thomas A, Hart J, Moore K, Harding K. Hyaluronic acid induces tumour necrosis factor-alpha production by human macrophages in vitro. Br J Plast Surg 1997; 50:362-8. [PMID: 9245871 DOI: 10.1016/s0007-1226(97)90546-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Foetal wounds heal with minimal or no scar formation. High levels of hyaluronic acid (HA) have been implicated as a contributory factor. Macrophages are essential for normal wound healing, a role facilitated by secretion of an array of cytokines. Of these, tumour necrosis factor alpha (TNF-alpha) has been shown to reduce wound collagen levels and thus scarring. This study examines the ability of HA to stimulate TNF-alpha production by human macrophages. The human U937 myelomonocytic cell line was differentiated into DU937 adherent macrophages. DU937 monolayers were exposed to HA at concentrations of 0.1, 1, 10 and 100 micrograms/ml. Conditioned media from HA-exposed monolayers were assayed for TNF-alpha activity using a standard L929 fibroblast bioassay. TNF-alpha activities of HA-exposed DU937 culture supernatants were compared to those of controls and expressed as % cytotoxicity. Exposure of macrophages to HA at concentrations of 10 micrograms/ml and 100 micrograms/ml significantly stimulated TNF-alpha production, as demonstrated by % cytotoxicities expressed as median (interquartile range) of 33.5 (29-34.5)% (P = 0.03) and 77.5 (67-85)% (P = 0.029) respectively (Mann-Whitney U test). This effect was specifically associated with TNF-alpha generated during HA exposure, as these cytotoxic effects could be abolished by addition of anti-TNF-alpha antibody, reducing cytotoxicity to 9 (6.5-13.5)% and 8.5 (6-12)% respectively. These observations indicate that HA stimulates TNF-alpha production by human macrophages. TNF-alpha is known to downregulate fibroblastic collagen synthesis within experimental wounds. We suggest that the high levels of HA within foetal wounds may play a part in limiting fibroplasia, and thereby limit scarring, via an upregulation of TNF-alpha production from wound macrophages.
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Affiliation(s)
- D E Boyce
- University Department of Surgery, University of Wales College of Medicine, Cardiff, UK
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Boyce DE, Whiston RJ, Young HL. Transecting the rectum: the 'clean cut' approach. Ann R Coll Surg Engl 1996; 78:191. [PMID: 8779502 PMCID: PMC2502697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- D E Boyce
- University of Wales College of Medicine, Cardiff
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Boyce DE, Crosby DL, Shandall AA. Aspects of hernia surgery in Wales. Ann R Coll Surg Engl 1995; 77:198-201. [PMID: 7598418 PMCID: PMC2502100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The management of elective inguinal herniorrhaphy in Wales was assessed by means of a postal survey of consultant general surgeons. This included technique of repair, length of inpatient stay, follow-up, use of heparin thromboprophylaxis and advice regarding driving, strenuous activities and work. In all, 54 replies (77%) were received. The views of patients on their surgery was assessed by a questionnaire sent to 80 patients treated on a single surgical unit; 60 replies (75%) were received. Waiting times were relatively short among this group, 67.5% of patients being treated within 6 months of seeking medical advice; 16.25% suffered a complication. All wound infections occurred after discharge and 15% of patients had some groin discomfort 6 months after operation. Accuracy of clinical examination of 50 inguinal hernias by different grades of surgeon was assessed. Consultants were significantly more accurate when compared with house officers (P < 0.001). There is a wide range of repair techniques and postoperative advice practised by consultant general surgeons in Wales. Patients' main complaint was that of a sparsity of postoperative advice, although there also appears to be an appreciable postoperative morbidity. Clinical experience plays a significant role in assessment of the suitability of hernias for surgery.
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Affiliation(s)
- D E Boyce
- Department of General Surgery, University Hospital of Wales, Cardiff
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Johnson RC, Fligelstone LJ, Boyce DE, Salaman JR. Rectus sheath haematoma: diagnosis is essential. Br J Clin Pract 1994; 48:269-70. [PMID: 7917823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R C Johnson
- Department of Surgery, Cardiff Royal Infirmary, Wales
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Fligelstone LJ, Boyce DE, Wheeler MH. Herniation at the site of cannula insertion after laparoscopic cholecystectomy. Br J Surg 1993; 80:1349. [PMID: 8242320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
Cement is a rare cause of full-thickness burns. We have examined the aetiology, frequency and severity of these burns, and assessed public awareness of the potential of cement as a caustic agent. Of patients, 95 per cent were unaware of the potential of cement to cause burns, and none had seen precautionary warnings on cement bags or delivery dockets. Factors important in burn production appear to be alkalinity, duration of contact and the abrasive nature of the cement particles. It is concluded that doctors, especially casualty officers, should know of the potential of progressive full-thickness burns from wet cement. General public awareness should be increased. The cement manufacturers were asked to comment on the content of this paper.
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Affiliation(s)
- D E Boyce
- Welsh Centre for Burns, Plastic and Maxillofacial Surgery, St Lawrence Hospital, Chepstow, Gwent, UK
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Boyce DE, Fligelstone LJ, Wheeler MH. An unusual complication of laparoscopic cholecystectomy. Ann R Coll Surg Engl 1992; 74:254-5. [PMID: 1416676 PMCID: PMC2497616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- D E Boyce
- Department of Surgery, Cardiff Royal Infirmary
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Brooke JD, Boyce DE, McIlroy WE, Robinson T, Wagar D. Transfer of variability from electromyogram to propulsive force in human locomotion. Electromyogr Clin Neurophysiol 1986; 26:389-400. [PMID: 3780523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hickey RJ, Clelland RC, Bowers EJ, Boyce DE. Health effects of atmospheric sulfur dioxide and dietary sulfites. The fallacy of typology. Arch Environ Health 1976; 31:108-12. [PMID: 816262 DOI: 10.1080/00039896.1976.10667201] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Some animal studies have shown that exposure to low levels of sulfur dioxide and dietary bisulfite is relatively harmless. To the contrary, sulfite oxidase deficiency is known in man, bisulfite is mutagenic for several test organisms, and the atmospheric SO2 level is positively correlated with death rates for several chronic diseases among some human populations. The studies reporting harmlessness for animals may be misleading because of the fallacy of typology.
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Hickey RJ, Clelland RC, Boyce DE, Bowers EJ. Letter: Cigarette smoke as a carcinogen? Am Rev Respir Dis 1975; 112:149. [PMID: 1147377 DOI: 10.1164/arrd.1975.112.1.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hickey RJ, Clelland RC, Boyce DE, Bowers EJ. Letter: Carboxyhemoglobin levels. JAMA 1975; 232:486-8. [PMID: 1173139 DOI: 10.1001/jama.1975.03250050012004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hickey RJ, Clelland RC, Boyce DE, Bowers EJ. Letter: Carboxyhaemoglobin: environmental and constitutional factors. Lancet 1975; 1:40-1. [PMID: 46359 DOI: 10.1016/s0140-6736(75)92402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hickey RJ, Clelland RC, Boyce DE, Bowers EJ. Letter: Cigarette smoke as a carcinogen? Am Rev Respir Dis 1975; 111:105-6. [PMID: 1111394 DOI: 10.1164/arrd.1975.111.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hickey RJ, Clelland RC, Boyce DE, Bowers EJ. Letter: Smoking, health, and confusion. JAMA 1974; 230:209-10. [PMID: 4479214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hickey RJ, Clelland RC, Boyce DE, Bowers EJ. Letter: Coffee, tobacco, and cardiovascular disease: the self-selection problem. JAMA 1974; 228:160. [PMID: 4406046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hickey R, Clelland RC, Boyce DE. Letter: Aryl hydrocarbons, smoking and lung cancer. N Engl J Med 1974; 290:576-7. [PMID: 4811116 DOI: 10.1056/nejm197403072901028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Hickey RJ, Clelland RC, Boyce DE, Harner EB. Air pollution, smoking and chronic disease: influence of constitutional factors. J Occup Med 1974; 16:4-5. [PMID: 4814110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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