RESUMO
As training opportunities in cosmetic surgery become less frequent in teaching hospitals, this survey set out to examine the attitudes of patients towards extending this training into the independent health sector. We questioned 155 private patients, 95% of who were happy for trainees to sit in during their consultations. Of these, 85% were comfortable with the presence of the trainee throughout their appointments and 92% said they saw advantages in having such trainees present. However, patients were less enthusiastic about trainees carrying out procedures, under consultant supervision and for a reduced fee. The survey found that while 49% felt it was a good idea, only 32% would consider it for themselves. Seventeen percent of patients thought this offer alone was inappropriate. This survey has shown that while the vast majority of private patients supported and were happy to participate in higher surgical training during private consultations, fewer would consider the possibility of cosmetic surgery performed by supervised trainees for reduced fees. The implications of these findings for higher surgical training in Plastic Surgery in the UK are discussed.
Assuntos
Atitude Frente a Saúde , Educação de Pós-Graduação em Medicina/métodos , Setor Privado , Cirurgia Plástica/educação , Adolescente , Adulto , Distribuição por Idade , Idoso , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Plástica/psicologiaAssuntos
Implantes de Mama/efeitos adversos , Mama/patologia , Reação a Corpo Estranho/patologia , Mastite/patologia , Falha de Prótese , Óleo de Soja/efeitos adversos , Feminino , Reação a Corpo Estranho/etiologia , Humanos , Hiperplasia/etiologia , Hiperplasia/patologia , Mastite/etiologia , Metaplasia/etiologia , Metaplasia/patologiaRESUMO
All the patients who had excision of basal cell carcinoma at the regional plastic surgery unit at Manchester over a period of 2 years from January 1995 to December 1996 were included in a retrospective audit. A total of 879 lesions were excised in 754 patients. In 41 lesions (4.7%) the tumour was incompletely excised, 16 of these lesions were further excised; the rest were managed by regular follow-up. The mean age of the incomplete excision group was slightly higher. The site where the incomplete excision rate was highest was the scalps followed by the ear, canthi,eyebrows and nose. There was a higher incidence of squamous differentiation and presence of foci of squamous cell carcinoma in the lesions excised incompletely. There was no statistically significant difference among the different groups of surgeons but in individual grades the rate was lower where more wounds were repaired by direct closure. The concept of a complexity ratio (number of wounds repaired by other methods/number of wounds repaired by direct closure) can be helpful in comparing the incomplete excision rates of different grades of surgeons or departments. The excision of basal cell carcinoma is one of the commonest procedures performed by all grades of surgeons in a plastic surgery department. Incomplete excision leads to further surgery or prolonged follow-up, thus significantly affecting the outcome. As the incidence of incomplete excision can be precisely monitored, it may be a useful tool for clinical governance.
Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Criança , Competência Clínica , Feminino , Humanos , Masculino , Auditoria Médica , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Distribuição por Sexo , Neoplasias Cutâneas/patologiaRESUMO
Wound healing in adult human skin results in varying degrees of scar formation, ranging clinically from fine asymptomatic scars to problematic hypertrophic and keloid scars, which may limit function and restrict further growth. At present, no good objective method of clinically assessing scars exists, which is problematic for the evaluation of scar prevention or treatment regimens. Similarly lacking are histologic correlates of what we consider good and bad clinical scars. The objective of this study was to quantitatively assess human scarring (1) clinically, by developing a comprehensive rating scale, (2) photographically, using an image capture system and a scar assessment panel, and (3) by histologic analysis following scar excision. We assessed 69 scars, with a wide clinical range of severity, in patients who were undergoing surgery, for whatever reason, that involved removal of an old scar. Preoperatively, patients had their scars assessed, clinically using our newly developed scale and photographically using a computerized image capture system. These photographs were then sent to a panel for assessment using similar criteria to those used clinically. Assessment of scars from photographs correlated well with the clinical scar evaluation, indicating its potential utility in multicenter scar prevention/treatment trials. Following excision, scars were processed and analyzed for histology. We also found a strong correlation between the macroscopic and microscopic appearance of scars, particularly between the clinical appearance and histologic scores of features in the epidermis and papillary dermis. This suggests that our clinical scale is a sensitive instrument in scar assessment, allowing validated quantification of the severity of a wide range of scars.
Assuntos
Cicatriz/diagnóstico , Adolescente , Adulto , Idoso , Cicatriz/patologia , Cicatriz/cirurgia , Derme/patologia , Epiderme/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fotografação , Cuidados Pré-OperatóriosRESUMO
Synovial sarcoma is rarely seen in the head and neck region. A case of synovial sarcoma of the pharynx in a child is presented.
Assuntos
Neoplasias Faríngeas/patologia , Sarcoma Sinovial/patologia , Criança , Humanos , Técnicas Imunoenzimáticas , Queratinas/análise , Masculino , Neoplasias Faríngeas/química , Sarcoma Sinovial/químicaRESUMO
Kasabach-Merritt syndrome is the association of thrombocytopenia, spontaneous bleeding, and enlargement of a haemangioma. It is caused by an intense, self-perpetuating process of clot-formation and lysis within the abnormal vascular channels of the haemangioma, and results in consumption of platelets and clotting factors. Treatment involves ablation of the lesion with or without pharmacological manipulation of the coagulation and fibrinolytic systems. No single therapeutic modality is universally successful but a combination of radiotherapy and corticosteroids can result in a dramatic, immediate response with minimal long term complications.
Assuntos
Transtornos da Coagulação Sanguínea/terapia , Dedos , Hemangioma Cavernoso/terapia , Trombocitopenia/terapia , Corticosteroides/uso terapêutico , Transtornos da Coagulação Sanguínea/radioterapia , Transfusão de Componentes Sanguíneos , Terapia Combinada , Seguimentos , Hemangioma Cavernoso/radioterapia , Humanos , Lactente , Masculino , Síndrome , Trombocitopenia/radioterapiaRESUMO
We describe the occurrence of a medulloblastoma and an astrocytoma in successive generations of a family with the Gorlin syndrome. The appearance of thousands of invasive basal cell carcinomata after craniospinal irradiation led to the death of one patient from intracranial involvement.
Assuntos
Síndrome do Nevo Basocelular/genética , Neoplasias Encefálicas/genética , Carcinoma Basocelular/genética , Neoplasias Cutâneas/genética , Adolescente , Adulto , Astrocitoma/patologia , Síndrome do Nevo Basocelular/patologia , Neoplasias Encefálicas/patologia , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/radioterapia , Humanos , Masculino , Meduloblastoma/patologia , Meduloblastoma/radioterapia , Neoplasias Induzidas por Radiação/patologia , Radioterapia/efeitos adversos , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologiaRESUMO
A mean 5 year review of 20 patients who had surgery for localised alopecia of the scalp is presented. The technique of using scalp expansion flaps is described and evaluated: it is associated with a low morbidity and high patient satisfaction rate; it provides an excellent one-stage procedure for intermediate size defects and, in the frontal area, for larger defects. Particular emphasis is laid on making incision lines at right angles to the direction of hair growth in order to cover stretched scars, and in performing Z-plasties when closing small scalp defects. Finally, a rationale for the treatment of localised areas of baldness according to their size is put forward.
Assuntos
Alopecia/cirurgia , Couro Cabeludo/cirurgia , Retalhos Cirúrgicos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Métodos , Complicações Pós-OperatóriasRESUMO
Two cases of complex limb threatening destruction of the wrist region and their reconstruction are described. The role of external fixation and composite vascular grafts in controlling infection and achieving bony union is outlined.
Assuntos
Traumatismos da Mão/cirurgia , Osteomielite/cirurgia , Infecção dos Ferimentos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Traumatismos do Punho/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The general anatomy and the detailed vascular anatomy of the latissimus dorsi myocutaneous flap is described, and its use as a free flap is illustrated. The speed and ease with which it can be raised, its long vascular pedicle, the large diameter of the donor vessels, and the potentially large size of the flap are emphasized.
Assuntos
Músculos/transplante , Transplante de Pele , Adulto , Idoso , Carcinoma Basocelular/cirurgia , Face/anormalidades , Feminino , Humanos , Traumatismos da Perna/cirurgia , Úlcera da Perna/cirurgia , Masculino , Pessoa de Meia-Idade , Músculos/anatomia & histologia , Músculos/irrigação sanguínea , Neoplasias Cutâneas/cirurgia , Transplante AutólogoAssuntos
Carcinoma Basocelular/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias Cutâneas/radioterapia , Adolescente , Adulto , Idoso , Carcinoma Basocelular/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Osteorradionecrose/etiologia , Lesões por Radiação/etiologia , Recidiva , Pele/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
Two children suffered injuries of the nasal columella and septum because, since infancy, their mother had obsessively scoured the nasal secretions from their noses with a metal Kirby grip. The reconstruction of the columellar loss in one child is described.
Assuntos
Maus-Tratos Infantis , Septo Nasal/lesões , Nariz/lesões , Cirurgia Plástica/métodos , Criança , Humanos , Masculino , Nariz/cirurgiaRESUMO
Hyperglucagonaemia and hypergastrinaemia were observed in some severely burnt patients during their illness. Hyperglucagonaemia seemed to be related to the severity of illness rather than to the burn itself, and the close correlation of glucagon concentrations with glucose and urea and its inverse correlation with bicarbonate concentrations suggest that glucagon might contribute to the hypercatabolic state. One patient developed high levels of gastrin and massive bleeding from a stress ulcer of the duodenum. Possibly gastrin hypersecretion may have a role in the pathogenesis of Curling's ulcer.