Reduction in skin cancer diagnoses in the UK during the COVID-19 pandemic.

The UK healthcare system, including skin cancer departments, has been profoundly affected by the COVID-19 pandemic. Despite service capacity and a worldwide increase in incidence, anecdotal reports suggest a decline in skin cancer diagnoses following COVID-19. To determine if there has been a decrease in skin cancer diagnosis in the UK in the COVID-19 era, we analysed data from the Northern Cancer Network from 23 March 2020 to 23 June 2020 and compared it with the same period in 2019 (pre-COVID). In the COVID period, there was a decrease of 68.61% in skin cancer diagnoses, from 3619 to 1136 (P < 0.01). Surprisingly, skin cancer waiting times were also reduced in the COVID period compared to the pre-COVID period (median of 8 and 12 days, respectively; P < 0.001). Collectively, these data highlight a statistically significant reduction in both skin cancer diagnoses and waiting times during the COVID period.

Single-stage helical rim reconstruction using a post-auricular bipedicled flap.

BACKGROUND: Middle-third helical rim defects may arise from trauma or oncological resection, and pose a challenging reconstructive problem. Reconstructing defects larger than 2 cm using traditional methods commits patients to the inconvenience of staged procedures. METHOD: This paper describes a single-stage helical rim reconstruction technique using a post-auricular bipedicled flap and ipsilateral conchal cartilage graft for delayed middle-third helical rim reconstruction. RESULTS: Two examples of this technique used in post-trauma and oncological reconstruction cases are presented, with pre- and post-operative photographs provided for demonstration. CONCLUSION: Contralateral graft harvest and staged operations for helical rim reconstruction are associated with donor site morbidity and the inconvenience of multiple operations to achieve the desired reconstructive outcome. Our single-stage helical rim reconstruction technique was well tolerated by patients, and showed satisfactory aesthetic results in terms of size and symmetry.

Bacterial colonisation of the burn wound: a UK experience.

OBJECTIVE: Bacterial colonisation of the burn wound remains a major source of morbidity and mortality in burns patients. This study aimed to determine the presence of different micro-organisms in a UK regional burns centre and to examine the relationships between bacterial colonisation, burn size, length of hospital stay and delayed referral. METHOD: A retrospective review of microbiology surveillance swab results on all adult patients admitted to a regional burns centre over a 12-month period was performed. RESULTS: 139 adult patients were included in the study. Approximately 68% of patients showed evidence of burn wound colonisation at some point during their inpatient stay. The remaining 32% had negative microbiology swabs throughout their hospital stay. A total of 202 micro-organisms were isolated. Staphylococcus aureus was found to be the most common micro-organism, found in 79% of patients with positive swab results. A direct link was found between an increased incidence of bacterial colonisation and delay in referral of >24 hours, larger burn size and length of hospital stay. CONCLUSION: By understanding the potential sources of bacteria and the effect of patient factors on their susceptibility to bacterial colonisation, we can form better management and treatment strategies to reduce morbidity and mortality from burns wound sepsis.

Two-stage delayed breast reconstruction with an expander and free abdominal tissue transfer: outcomes of 65 consecutive cases by a single surgeon.

BACKGROUND: Traditional single-stage breast reconstruction with autologous tissue leaves an obvious skin island. Alternatively, a staged reconstruction with the creation of a skin envelope with a tissue expander which is then replaced with a de-epithelialised flap, leaves a breast with the original mastectomy scar and no skin island. METHODS: Consecutive patients who underwent the two-stage reconstruction between 2004 and 2010 were included in the study. Data were collected retrospectively on patient demographics, adjuvant treatments, surgical procedures and outcomes. RESULTS: A total of 65 patients who initially had a non-skin sparing mastectomy underwent two-stage breast reconstruction, of which the majority were delayed (n = 63, 95%) and unilateral (n = 64, 98.5%). Each patient was individually assessed for their suitability for the two-stage reconstruction. In 89% (n = 58) of cases, the expander was inserted in a subcutaneous pocket, while in the remaining a subpectoral pocket was elected. After the first stage, seven complications were recorded (10.7%), notably three expander extrusions, three seromas and one implant infection. Of the 65 patients, 63 proceeded to the second stage of reconstruction with 38 transverse rectus abdominis myocutaneous (TRAM) (60%), 12 superficial inferior epigastric artery (SIEA) (19%), and 13 deep inferior epigastric perforator (DIEP) (21%) flaps. Mean follow-up time since the completion of the second stage was 42 months (range 6-80 months), with complete flap loss recorded in 4.6% and minor fat necrosis in 9.5% of cases. CONCLUSIONS: The two-stage breast reconstruction using skin expansion and autologous tissue transfer eliminates the need for a visible skin paddle and produces a sensate breast with a more natural-looking breast mound.

Nasal chondromesynchymal hamartoma presenting in an adolescent.

Nasal chondromesenchymal hamartoma (NCMH) is extremely uncommon primary benign cartilaginous growth of the nasal and paranasal sinuses. To date, it has been reported almost exclusively in infancy. We report a NCMH in a 16-year-old patient who presented with an asymptomatic, fixed swelling on the left side of the nose approximately 2x2 cm in size. Computed tomography (CT) and magnetic resonance imaging (MRI) of the nose, paranasal sinuses and neck confirmed a heterogeneous, calcified polypoidal mass protruding caudally into the left nasal cavity. After an initial inconclusive incisional biopsy, the patient underwent a complete radical resection, with staged reconstruction of the full nasal defect using septal mucosal flap, conchal cartilage graft and forehead skin flap. Histological examination of the resected specimen confirmed NCMH, which, we believe, had probably been present and undetected for many years. This report greatly extends the age at which NCMH may be entertained as part of the differential diagnosis of cartilaginous lesions of the nose and paranasal sinuses.