National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: An argument about timing

OBJECTIVE

To conduct a systematic review to gather the available evidence on the optimum timing of the radiotherapy in relation to autologous breast reconstruction.

MATERIAL AND METHODS

The data was extracted from scientific databases, and a manual follow-up of references. The studies were selected which included at least 20 patients with any method of autologous breast reconstruction who were treated with adjuvant radiotherapy either before or after their reconstruction, and had addressed the effects of radiotherapy on the cosmetic outcome in their results. The principal outcome was cosmetic appearance. Secondary outcomes were immediate and delayed complications.

RESULTS

We could not find any randomised controlled trial on this topic. Ten studies were included, most were retrospective, heterogeneous in terms of control groups, radiation doses, follow-up duration, and outcome measurements. Two studies included no control groups, and four studies compared the outcomes of patients with radiotherapy either before (n=3) or after (n=1) autologous breast reconstruction. The overall incidence of complications was increased in patients with radiotherapy in three out of these four studies. Only four studies directly compared the outcomes of patients who received radiotherapy before with patients who received radiotherapy after autologous breast reconstruction and two out of these reported worse outcomes associated with post-reconstruction radiotherapy.

CONCLUSIONS

Despite the paucity of the published data, the current evidence suggests that the radiation has a deleterious effect on autologous flap reconstruction. Until better methods of radiation delivery can be devised to minimise the long term radiation sequelae in the irradiated tissue, delayed reconstruction seems to be a safe option in most of the cases. However, the findings from these studies should be interpreted with great caution before generalising from their results.

End-to-side venous anastomoses....a patency test

A hitherto unpublished means of testing the patency across an end-to-side venous anastomosis is described. It relies on the elasticity of the venous walls to produce ballooning when the appropriate segments of the veins are occluded and blood is flowing unimpeded across the end-to-side anastomosis. It is foolproof, easy to perform and has no ambiguity in its interpretation.

Letters

USE OF MEPITEL IN SKIN CRAFT DONOR SITES USE OF MEPITEL ON PUNCH CRAFT SITES EPIDERMOLYSIS BULLOSA.

Letters

COMMUNITY GUIDELINES ON PRESSURE AREA CARE NECROTISING FASCIITIS INTERNET SOURCES MEPITEL: A 'STICKY' SUBJECT.

An audit of velopharyngeal incompetence treated by the Orticochea pharyngoplasty

An audit of patients with velopharyngeal incompetence treated by the Orticochea pharyngoplasty was undertaken. 54 patients who had been treated by a single surgeon over a 10-year period were identified. All patients had pre- and postoperative speech therapy and were followed up for an average of 6 months. 49/54 patients had lessening of their nasal escape; in 40/54 it was eliminated completely. Nasal resonance was assessed as normal in 46/54 of patients postoperatively. The results are compared with those of other similar studies.

The "mini-Bier's block": a new technique for prevention of tourniquet pain during axillary brachial plexus anaesthesia

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the "mini-Bier's block"), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.

The Read clinical classification and its use in plastic surgery

The recording of medical data has developed from crude non-specific classifications to complex systems tailor-made for individual practices. The development of the Read Clinical Classification has produced a complex classification which is user friendly and covers the whole of medicine. The classification allows unique medical concepts to be assigned preferred descriptive terms, each of which has a unique identifying code. The system allows very specific data to be recorded by using strings of linked codes. The development of the classification has led to an improvement in the way data for plastic surgery can be recorded. This paper outlines the principles used in the development of the terms for plastic surgery, and how they may be used in the future.

A bipedicled neurovascular step-advancement flap for soft tissue lengthening in clinodactyly

Recommendations for the surgical treatment of clinodactyly have centered on techniques of osteotomy with or without bone grafting. However, the limiting factor to the correction may be tension in the soft tissues. A new technique to correct clinodactyly is described utilising an opening wedge osteotomy and bone grafting plus a bipedicled neurovascular step-advancement flap to correct the soft tissue deficiency. The procedure has been performed in five cases.

Nasal symmetry: a 10-year comparison between the Pigott and McComb nasal correction

The objective assessment of the symmetry of the cleft lip nose has not been properly evaluated. A simple technique using enlarged photographs and area assessment is described. Two different techniques were assessed, the Pigott "alar leapfrog" technique and the McComb alar lift technique. The children were assessed at 10 years of age. The results show no differences in the linear measurements or when the symmetry is assessed in the frontal view. In the worm's eye view, the Pigott correction was shown to produce a more asymmetric nose when compared with the McComb technique. Both corrections produce significant asymmetry when compared with a control group.

Plastic surgery audit codes: are the results reproducible?

The effective coding of data to produce a medical audit relies on agreement between the coders. This study was designed to assess whether coders can agree on codes for diagnosis and operations in a plastic surgery unit. Information from 50 patients was presented to a panel of six coders who were required to code the data using the International Classification of Diseases (ICD-9) and the Office of Population Census Studies (OPCS-4) systems. The results show that agreement between all the panellists occurred in only 32 out of 50 patients for one diagnostic code and 30 out of 50 for one operation code. When a patient had more than one diagnosis or operation, agreement was very much worse. Expert coders produced better results than the medical coders. The results are discussed with reference to other coding systems.

Review of burns caused by bitumen and the problems of its removal

Bitumen burns are difficult to treat as the substance adheres to the skin. Twenty-four patients with such burns admitted as inpatients over a 9-year period have been reviewed. The mean size of the burn injury was 3 per cent of the total body surface area (mean full thickness burn: 1 per cent). Sixteen patients required operative treatment to achieve healing but no secondary reconstructive procedures have been performed. Twenty-two patients, who were burned at work, returned to their original employment within 2 months of injury. There was no decrease in the need for operation or decrease in the time to healing in those patients who had attempted early removal of the bitumen. Suggested principles of management are: cool the bitumen continuously with cold water until hard to dissipate the retained heat, leave the bitumen intact except around the eyes, and deroof tense blisters.