Subject(s)
COVID-19/epidemiology , Hand Injuries/surgery , Pandemics , Plastic Surgery Procedures/methods , SARS-CoV-2 , Comorbidity , Female , Humans , Incidence , London/epidemiology , Male , Time FactorsABSTRACT
BACKGROUND: Earthquakes are the leading cause of natural disaster-related mortality and morbidity. Soft tissue and musculoskeletal injuries are the predominant type of injury seen after these events and a major reason for admission to hospital. Open fractures are relatively common; however, they are resource-intense to manage. Appropriate management is important in minimising amputation rates and preserving function. This review describes the pattern of musculoskeletal and soft-tissue injuries seen after earthquakes and explores the manpower and resource implications involved in their management. METHODS: A Medline search was performed, including terms "injury pattern" and "earthquake," "epidemiology injuries" and "earthquakes," "plastic surgery," "reconstructive surgery," "limb salvage" and "earthquake." Papers published between December 1992 and December 2012 were included, with no initial language restriction. RESULTS: Limb injuries are the commonest injuries seen accounting for 60 % of all injuries, with fractures in more than 50 % of those admitted to hospital, with between 8 and 13 % of these fractures open. After the first few days and once the immediate lifesaving phase is over, the management of these musculoskeletal and soft-tissue injuries are the commonest procedures required. CONCLUSIONS: Due to the predominance of soft-tissue and musculoskeletal injuries, plastic surgeons as specialists in soft-tissue reconstruction should be mobilised in the early stages of a disaster response as part of a multidisciplinary team with a focus on limb salvage.
Subject(s)
Earthquakes , Fractures, Bone/surgery , Musculoskeletal System/injuries , Physician's Role , Soft Tissue Injuries/surgery , Surgery, Plastic , Amputation, Surgical/statistics & numerical data , Disasters , Fractures, Open/surgery , Humans , Limb Salvage , Plastic Surgery ProceduresSubject(s)
Melanoma/pathology , Nail Diseases/pathology , Skin Neoplasms/pathology , Adult , Female , HumansABSTRACT
Clinical governance is the structured approach to maintaining and improving the quality of patient care and is a vital part of global surgery. BFIRST and BSSH closely collaborate with local doctors on a number of overseas projects, seeking to strengthen and develop local knowledge and skills, aiming for an independent local practice in reconstructive and upper limb surgery. Thoughts on essential requirements, improvements and pitfalls in the ethical approach to global collaboratives are presented.
Subject(s)
Medical Missions/organization & administration , Plastic Surgery Procedures/standards , Quality Assurance, Health Care/organization & administration , Aftercare , Capacity Building/organization & administration , Global Health , Humans , Informed Consent , Quality Assurance, Health Care/methodsSubject(s)
COVID-19 , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Delivery of Health Care , Infection Control , Occupational Exposure/prevention & control , Plastic Surgery Procedures , Skin Neoplasms , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Outcome and Process Assessment, Health Care , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/standards , Plastic Surgery Procedures/trends , SARS-CoV-2 , Skin Neoplasms/diagnosis , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , United Kingdom/epidemiologyABSTRACT
UNLABELLED: Limited studies exist on the outcome of replacing an amputated fingertip as a composite graft. We report the outcomes and predictors for composite graft survival along with the long-term morbidity. A retrospective review of all patients <16 years who underwent composite graft replacement of an amputated fingertip was performed. Long-term morbidity was evaluated through a standardized parental questionnaire. A total of 120 patients were identified, of whom 97 were eligible for inclusion. Parental questionnaires were completed for 42 (43%) patients. There was a 10% complete and 34% partial graft survival rate. Patients aged ⩽4 were significantly more likely to have complete graft take than those >4. Of the patients, 17% developed post-operative complications; 48% of patients reported a hook-nail deformity and 17% reported cold intolerance. Only 5% of patients reported any functional difficulties long term. The rate of complete composite graft survival in a paediatric population is low, although the long-term function of these patients is good. LEVEL OF EVIDENCE: 3.
Subject(s)
Amputation, Traumatic , Finger Injuries/surgery , Replantation/methods , Adolescent , Child , Child, Preschool , Female , Graft Rejection , Graft Survival , Humans , Infant , Male , Retrospective Studies , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Conservative Treatment/methods , Dissection , Hidradenitis Suppurativa , Plastic Surgery Procedures , Postoperative Complications , Reoperation , Adult , Dissection/methods , Dissection/statistics & numerical data , Drainage/methods , Drainage/statistics & numerical data , Female , Hidradenitis Suppurativa/epidemiology , Hidradenitis Suppurativa/physiopathology , Hidradenitis Suppurativa/therapy , Humans , Male , Patient Selection , Postoperative Complications/classification , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Recurrence , Reoperation/methods , Reoperation/statistics & numerical data , Surgical Flaps/statistics & numerical data , United Kingdom/epidemiology , Wound HealingABSTRACT
The influence of topically applied tap water on the mechanical properties of human skin was studied in vivo by applying tap water to the ventral aspect of the forearms of 18 healthy volunteers for 10 or 20 minutes and then measuring distensibility, elastic retraction, and hysteresis. Significant increases in distensibility, resilient distensibility, and hysteresis were noted after 20 minutes of soaking. Most of these findings were already apparent after 10 minutes. This study shows that the epidermis plays a significant role in determining the mechanical properties of human skin. Possible practical implications of superficial skin hydration for plastic surgery such as tissue expansion and larger excisions are briefly discussed.
Subject(s)
Skin Physiological Phenomena , Water/administration & dosage , Adult , Aged , Aged, 80 and over , Biomechanical Phenomena , Dermatologic Surgical Procedures , Elasticity , Female , Humans , Male , Middle Aged , Surgery, PlasticABSTRACT
Vinorelbine tartrate (Navelbine, Burroughs Wellcome Company, Research Triangle Park, NC, USA) is a semisynthetic vinca alkaloid approved in many countries for the first-line treatment of patients with advanced non-small-cell lung cancer. It is also used in the treatment of advanced breast and ovarian cancers and lymphoma. Like other vinca alkaloids, Navelbine can cause skin necrosis as a consequence of inadvertent extravasation in surrounding tissues during intravenous administration. In such cases, early treatment is strongly advocated. There is no documented case of vinorelbine extravasation in the literature. The authors herein report two cases successfully treated with hyaluronidase injections plus saline flushout under local anesthesia.
Subject(s)
Antineoplastic Agents, Phytogenic/adverse effects , Hand Injuries/drug therapy , Hyaluronoglucosaminidase/therapeutic use , Vinblastine/analogs & derivatives , Vinblastine/adverse effects , Anesthesia, Local , Antineoplastic Agents, Phytogenic/administration & dosage , Extravasation of Diagnostic and Therapeutic Materials , Female , Humans , Hyaluronoglucosaminidase/administration & dosage , Middle Aged , Sodium Chloride/therapeutic use , Treatment Outcome , Vinblastine/administration & dosage , VinorelbineABSTRACT
Dupuytren's contracture shares certain properties with malignant tumours, characterized by proliferation and lack of apoptosis, which may be induced by the c-myc oncogene. Because of these similarities, the relationship between the c-myc oncogene expression, bcl-2 oncogene (anti-apoptotic gene) and proliferation was investigated in Dupuytren's disease. Proliferation was assessed by immunohistochemical staining of the mib-1 antibody. Results were compared with those from fibrosarcoma specimens, representing a related malignant tumour. Non-diseased fascia from Dupuytren patients and flexor retinaculum from patients undergoing carpal tunnel release without Dupuytren's disease were used as controls. Expression of c-myc was elevated in primary Dupuytren's disease and fibrosarcoma specimens, whilst recurrent Dupuytren's disease, non-diseased Dupuytren fascia and flexor retinaculum exhibited significantly lower levels. Neither bcl-2 nor mib-1 were detected in Dupuytren's disease, non-diseased fascia or flexor retinaculum, in contrast to fibrosarcoma. The imbalance between proliferation and apoptosis, producing malignant growth was thus confirmed for fibrosarcoma, but not for Dupuytren's disease.
Subject(s)
Dupuytren Contracture/genetics , Dupuytren Contracture/pathology , Fibrosarcoma/genetics , Genes, bcl-2/genetics , Genes, myc/genetics , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Cell Death/genetics , Cell Division/genetics , Cytoplasm/chemistry , Diagnosis, Differential , Fascia/chemistry , Fascia/cytology , Fascia/pathology , Female , Fibroblasts/cytology , Fibrosarcoma/pathology , Gene Expression , Humans , Immunohistochemistry , Male , Middle Aged , Recurrence , Reference Values , Sensitivity and Specificity , Statistics, NonparametricABSTRACT
5-Fluorouracil reduces proliferation rates of fibroblasts, myofibroblast differentiation and contractility of ocular fibroblasts in vitro. This double-blind randomized clinical trial assesses whether intra-operative topical treatment with 5-fluorouracil reduces the recurrence rate after limited excision of Dupuytren's tissue. Patients with two-digit disease were randomized to having 5-fluorouracil (25mg/ml) treatment for 5 minutes on one digit and placebo on the other. Fifteen patients were enrolled with 18 months follow-up. There were no peri-operative complications. Wound healing was not delayed and there was no deterioration in the flexion deformity of the 5-fluorouracil treated digits. Patients were subsequently assessed by joint angle measurement at 3, 6, 12 and 18 months. There was no significant difference between control and 5-fluorouracil treated digits.
Subject(s)
Antimetabolites/therapeutic use , Dupuytren Contracture/drug therapy , Fluorouracil/therapeutic use , Double-Blind Method , Dupuytren Contracture/surgery , Humans , Intraoperative Period , Male , Middle Aged , Prospective Studies , Secondary Prevention , Treatment OutcomeABSTRACT
The giant solitary trichoepithelioma is a rare trichogenic tumor with potential for local recurrence. Only nine cases have been previously described in the literature, and one additional case without recurrence during the first 3.5 years of observation is presented stressing that the rate of recurrence is low.
Subject(s)
Neoplasms, Basal Cell/pathology , Skin Neoplasms/pathology , Hair Follicle/pathology , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: Dupuytren's disease is a proliferative disease with contractile properties, prone to recur after surgery. Intra-operatively applied 5-fluorouracil has been used to avoid scar problems in the eye after glaucoma filtration surgery and was therefore investigated as a means to inhibit proliferation and myofibroblast differentiation in Dupuytren fibroblasts in vitro. METHOD: Primary cell lines were obtained by explants from Dupuytren's tissue (n = 6), non-diseased palmar fascia from patients with Dupuytren's disease (n = 3) and carpal ligament from patients undergoing carpal tunnel release (n = 3). The effect of 5-fluorouracil on proliferation was assessed by cell counting. Myofibroblast differentiation, an intergral part of Dupuytren's contracture, was investigated by staining for alpha smooth muscle actin, a marker for contractile cells, using immunohisto-chemical methods. RESULTS: A single exposure to 5-fluorouracil caused a sustained inhibition of proliferation in Dupuytren's and non-diseased fascia cultures, whilst the effect on carpal ligament cultures was transient. Untreated Dupuytren's fibroblasts exhibited the highest myofibroblast differentiation, whilst differentiation in non-diseased fascia cultures was shown to be proportional to cell density and virtually non-existent in carpal ligament cultures. After 5-fluorouracil exposure, the differentiation was significantly reduced in Dupuytren's fibroblasts cultures, reduced at high cell densities in non-diseased fascia and unchanged in carpal ligament cell cultures. DISCUSSION: 5-fluorouracil inhibits both proliferation and myofibroblast differentiation in Dupuytren's cell cultures and may have a potential use as an adjuvant treatment to Dupuytren surgery in order to reduce the rate of recurrence and contracture.
Subject(s)
Antimetabolites/therapeutic use , Dupuytren Contracture/drug therapy , Dupuytren Contracture/pathology , Fibroblasts/drug effects , Fibroblasts/physiology , Fluorouracil/therapeutic use , Aged , Antimetabolites/pharmacology , Case-Control Studies , Cell Count/drug effects , Cell Differentiation/drug effects , Cell Division/drug effects , Cells, Cultured/drug effects , Chemotherapy, Adjuvant , Drug Evaluation, Preclinical , Dupuytren Contracture/physiopathology , Dupuytren Contracture/surgery , Female , Fluorouracil/pharmacology , Humans , Male , Middle Aged , Myofibrils/drug effects , Myofibrils/physiology , RecurrenceSubject(s)
Closed Fracture Reduction/methods , Finger Phalanges/injuries , Fractures, Bone/therapy , Gloves, Surgical , Adolescent , Adult , Aged , Aged, 80 and over , Bone Wires , Female , Humans , Male , Middle Aged , Physical Therapy Modalities , Young AdultABSTRACT
'Madura foot' or mycetoma is a chronic granulomatous soft-tissue infection, caused by either true fungi (eumycetoma) or Gram-positive aerobic bacteria (actinomycetoma). The infection is endemic to equatorial, tropical or sub-tropical regions. However, sporadic cases have been reported in the Western world mostly in the migrant population. The disease follows a slow progression from the time of traumatic inoculation to presentation of symptoms, characterised by a triad of chronic indurated swelling, draining sinuses and discharging granules. The granules are diagnostic as they represent collections of fungal hyphae or bacterial filaments. We present a case of a 4-year eumycetoma of the left foot in a 16-year-old Somalian girl, resident in the UK for over a year. She underwent aggressive surgical debridement with a 6-month course of anti-fungal medication. We emphasise the need for suspicion of this rare dermatosis, in view of the increasing immigrant population.