Systematic review: anastomotic microvascular device.

BACKGROUND: Anastomotic microvascular device has gained popularity in reconstructive microsurgery over the last two decades. A systematic literature search has been carried out in the use of the venous coupler device in microsurgery to assess its impact on patency rate in microsurgery. METHOD: Using key words related to the topic, a literature search of major databases was carried out. Selection was undertaken on two level screening. From the literature search 53 potential articles were identified. Of these 13 met both levels of screening for the final critical analysis. RESULTS: A total of 2976 venous anastomoses with coupler device were carried out in the 13 studies with a combined thrombosis in 46 veins reported, giving an average 98.5% patency and a variation in thrombosis rate ranging from 0 to 3%. CONCLUSION: The venous coupler device serves as a powerful instrument in microsurgery by achieving high patency rate. More importantly the data suggests less variation in thrombosis rate compared to hand-sewn venous anastomosis.

Squamous cell carcinoma arising in epidermoid cysts: report of four cases and review of the literature.

Epidermoid cysts are commonly encountered in clinical practice and while the majority are benign, isolated cases of premalignant and malignant conditions have been identified in their walls. We report four cases of squamous cell carcinoma arising in the walls of epidermoid cysts and review the literature.

Long term study into surgical re-exploration of the 'free flap in difficulty'.

BACKGROUND: Free tissue transfers must survive in order to achieve their surgical goals. There is little consensus about managing the 'failing' free flap, and practice is often guided by anecdote. MATERIAL AND METHODS: We have prospectively collected data about all free flaps performed within our department between 1985 and 2008 (2569 flaps). We identified 327 flaps which were re-explored a total of 369 times. We analysed these flaps with regard to indication for re-exploration, operative findings and outcome. RESULTS: Thirteen percent (327) of free flaps were re-explored. Of these, 291 (83%) had a successful outcome. Successful re-explorations took place at a mean 19h post-op and unsuccessful re-explorations at a mean 56h post-op. Clinical diagnosis prior to re-exploration was confirmed operatively in 91% of cases. CONCLUSION: We have considered the factors that allowed us to achieve the salvage rates described over a prolonged period, and identified two key areas. Firstly, we favour a model for free flap monitoring with clinical judgement at its core. Secondly, we feel the facility to recover patients post-operatively in a specialised, warmed environment, and return them to theatre quickly should the need arise, is essential. These two simple, yet institutionally determined factors are vital for maintaining excellent success rates.

Blood ordering protocol based on proposed surgical implant in fractured neck of femur patients.

INTRODUCTION: Fractured neck of femur patients frequently require blood transfusion. To improve the efficiency of blood ordering, we present a protocol which orders blood specific for the proposed surgical implant. PATIENTS AND METHODS: A retrospective audit over a 1-year period was performed. Patients were divided into six groups dependent on proposed surgical implant. The mean postoperative drop in haemoglobin concentration, the cross-match to transfusion ratio and transfusion indexes were calculated. RESULTS: Statistically significant differences in blood loss were found dependent on implant used. Using guidelines created by the British Committee for Standards in Haematology on the implementation of a maximum surgical blood ordering schedule, a new protocol for blood ordering based on proposed surgical implant was created. CONCLUSIONS: In fractured neck of femur patients awaiting operation, the type of implant can be used to anticipate blood loss and as a guide to blood ordering.

Oral cancer, fever of unknown origin, and listeriosis.

Listeriosis is a rare cause of fever of unknown origin in patients with oral cancer. We report two patients who, because of pain and discomfort, ate large quantities of soft cheeses; this caused listeriosis and fever. Both cases responded to high doses of amoxycillin.

The double-barrelled end-to-end microvascular anastomosis.

We describe a simple alternative method of microvascular anastomosis to the internal jugular vein, which is useful when part of the internal jugular vein has been sacrificed and the free flap has two draining venae commitantes. In our hands, this method has proven to be quick, efficient and successful.