FFP3 Feelings and Clinical Experience (FaCE). Facial pressure injuries in healthcare workers from FFP3 masks during the COVID-19 pandemic.

AIMS: Prolonged wear of filtering facepiece 3 (FFP3) masks during the COVID-19 pandemic has led to dermatoses, including pressure sores. This study aimed to better understand the local scale and nature of the problem, coping strategies, and impact on those affected. METHODS: A survey was designed by plastic surgeons, tissue viability nurses, and critical care doctors. Key elements were demographics, mask-wearing behaviours, facial injuries, coping mechanisms, and impacts, such as time off work or redeployment. Question types were multiple-choice questions, visual analogue scales, and blank space. It was distributed for voluntary completion at a London NHS Trust via staff update emails and posters. RESULTS: Between 24th April-15th May 2020, 178 surveys were completed in full. Participants were 84% female, 55% worked in ITU, and 48% were nurses. Grade 1 facial pressure injuries were reported by 79% of respondents (n=124). Other significant occupational dermatoses included pain (70%), dry skin (50%), and acne (41%). The cheeks and bridge of nose were most affected. Staff used barrier creams (17%), dressings (17%), and analgesia (10%) to manage facial injuries. Half of those who modified their mask were not re-fit tested. A total of 33% required redeployment to a non-FFP3 area or time off. CONCLUSIONS: FFP3 masks worn beyond the recommended 1 h are associated with facial injuries. When advanced PPE (i.e., powered airflow masks) is unavailable, we must provide targeted skincare support (prevent and manage), modify shift patterns to reduce mask wear intensity, and amend fit test protocols to optimise protection against COVID-19.

A correlation analysis of metacarpal & phalangeal injury pattern from improvised explosive devices amongst armed force personnel.

Injuries to the hand during military combat operations, particularly from improvised explosive devices (IEDs) have a significant impact on form, function, mental health and future employment but remain underreported amidst the life and limb-threatening emergencies that garner more attention. An understanding the patterns of hand injuries encountered from IEDs is crucial to optimizing reconstruction and rehabilitation. The aim of this study was to re-evaluate hand injury sustained from IED in order to understand the clinical burden for reconstruction and direct the focus for future hand protection. We identified 484 hand injuries in 380 patients sustained as a result of IEDs among military personnel service in Afghanistan between 2006 and 2013. 53% of all surviving military personnel injured by IEDs sustain injuries to the hand. Analysis of the 103 patients who sustained injury to the metacarpal, phalanges or digital amputation revealed that the middle and ring fingers are most commonly injured. Amputation to the ring finger is strongly associated with injury to the adjacent fingers and amputations to the middle, ring and little fingers concurrently is a commonly observed pattern. The proximal phalanges of the middle and ring fingers had a strong correlation for fracture together. These findings disprove the conventional belief in an ulnar focus of injury and support the quest for a development of combat hand protection that addresses the injury pattern seen.

Plastic surgical operative workload in major trauma patients following establishment of the major trauma network in England: A retrospective cohort study.

INTRODUCTION: The introduction of major trauma centres (MTCs) in England has led to 63% reduction in trauma mortality.(1) The role of plastic surgeons supporting these centres has not been quantified previously. This study aimed to quantify plastic surgical workload at an urban MTC to determine the contribution of plastic surgeons to major trauma care. METHODS: All Trauma Audit and Research Network (TARN)-recorded major trauma patients who presented to an urban MTC in 2013 and underwent an operation were identified retrospectively. Patients who underwent plastic surgery were identified and the type and date of procedure(s) were recorded. The trauma operative workload data of another tertiary surgical specialty and local historical plastics workload data from pre-MTC go-live were collected for comparison. RESULTS: Of the 416 major trauma patients who required surgical intervention, 29% (n = 122) underwent plastic surgery. Of these patients, 43% had open lower limb fractures, necessitating plastic surgical involvement according to British Orthopaedic Association Standards for Trauma (BOAST) 4 guidance. The overall plastic surgery operative workload increased sevenfold post-MTC go-live. A similar proportion of the same cohort required neurosurgery (n = 115; p = 0.589). DISCUSSION: This study quantifies plastic surgery involvement in major trauma and demonstrates that plastic surgical operative workload is at least on par with other tertiary surgical specialties. It also reports one centre's experience of a significant change in plastic surgery activity following designation of MTC status. The quantity of plastic surgical operative workload in major trauma must be considered when planning major trauma service design and workforce provision, and for plastic surgical postgraduate training.

Synovial chondromatosis of the metacarpophalangeal joint.

We describe a case of synovial chondromatosis in a metacarpophalangeal joint with invasion of local structures. The degree of local tissue involvement was not demonstrated on the preoperative MRI scans. This case highlights that synovial chondromatosis can be invasive and that even the best preoperative imaging may not demonstrate this.

Rehabilitation of lower limb traumatic amputees: the Sandy Gall Afghanistan Appeal's experience.

Physical rehabilitation after lower limb traumatic amputation due to acts of war has not yet been investigated. It has been shown that patients suffering non-war injuries rehabilitate well. This study shows that despite the difficult circumstances and limited resources available in an area of conflict, good rehabilitation of war victims is possible. However, economic rehabilitation is worse than that seen in non-war populations. Given that this type of injury is very common in war zones worldwide, this failure of economic rehabilitation may represent a major healthcare issue.

Psychosocial benefits of sentinel lymph node biopsy in the management of cutaneous malignant melanoma.

Lymphoscintigraphy combined with sentinel lymph node biopsy has become a powerful and sensitive tool in establishing nodal spread in cutaneous melanoma, as well as in breast and other cancers. Although the technique is reliable and validated, there is, as yet, no proven clinical benefit. A suggested benefit of sentinel lymph node biopsy is that a negative biopsy may decrease the psychological morbidity associated with malignancy by reassuring the patient that he or she has localised disease. We studied a group of patients with cutaneous melanoma who underwent sentinel lymph node biopsy, and found that although they did gain some psychosocial benefit from the procedure, this was short term and they were still significantly concerned about their disease status.

Sentinel lymph node biopsy in malignant melanoma: a series of 100 consecutive patients.

A consecutive cohort of 100 patients who had undergone sentinel lymph node biopsy (SLNB) was analysed retrospectively. Three areas were studied: success in finding the sentinel node(s); complications of the procedure; and extra costs incurred by SLNB. The sentinel node(s) were successfully identified in 98% of the lymph node basins biopsied. The overall complication rate was 33%. The additional cost of the procedure was estimated at 1420 pounds sterling per patient. SLNB can reliably identify the sentinel node. However there is a significant complication rate of the technique and considerable additional costs. SLNB requires further critical evaluation before it can be accepted as a standard treatment for patients with malignant melanoma.