A study to compare strengths of cadaveric tendon repairs with round-bodied and cutting needles.

This human cadaver study investigated whether flexor tendon repairs performed with round-bodied needles had a higher risk of pull-out compared with those performed with cutting needles. Forty human cadaver tendons were repaired (20 with each type of needle), subjected to tensile traction testing and evaluated by failure load and mode of failure. The average failure load was 50 N (SD 13 N) for tendons repaired with round-bodied needles, compared with 49 N (SD 16 N) for tendons repaired with cutting needles. Round-bodied needles resulted in more suture pull-out (18 out of 20 tendons) than cutting needles (6 out of 20 tendons). We found no differences in failure load, but significant differences in the mode of failure between round-bodied and cutting needles when used for cadaveric flexor tendon repair.

Hand Therapist Led Follow-up for Paediatric Hand Trauma - a Retrospective Study of 139 Closed Hand Injuries.

BACKGROUND: Most hand injuries in children can be managed non-operatively and are associated with excellent outcomes. Whilst the majority of our patients are discharged to the care of hand therapists, there is no literature to support this protocol. Our aim was to ensure this is safe and effective practice. MATERIAL AND METHODS: We conducted a retrospective analysis of all patients referred to our paediatric hand trauma clinic for closed injuries over a four month period between December 2014 and March 2015. Data related to demographics, injury pattern and clinical outcomes was recorded and analysed. A telephone interview with a patient satisfaction questionnaire was attempted with all patients discharged to the care of hand therapists. RESULTS: 139 patients were seen in the study period, including 90 males and 49 females. Phalangeal fractures (39%), volar plate injuries (19%) and metacarpal fractures (16%) were the commonest causes of hand trauma. The majority of patients (88%) were managed non-operatively. 97 patients were discharged to hand therapy follow-up and we managed to contact 51 patients (53%). Fifty-one patients (100%) completed a patient satisfaction questionnaire. 100% of the parents were happy with the care, 96% were not disappointed they did not see a doctor and 96% denied any complications. CONCLUSION: 1. The majority of paediatric hand injuries can be managed non-operatively with excellent outcomes. 2. Hand therapy led follow-up is appropriate for a selected group of paediatric hand injuries. This study pro-ves that it is safe and effective for the majority of closed hand trauma, as illustrated by low complication rates. 3. Hand therapist led follow up for paediatric hand injuries is associated with high patient satisfaction.

Subcutaneous Phaeohyphomycosis Cyst Associated with Medicopsis romeroi in an Immunocompromised Host.

An 88-year-old man, receiving prednisolone for sarcoidosis, presented with a discrete keratotic lesion on the dorsum of his right hand following the placement of an intravenous cannula a month prior to its appearance. Medicopsis romeroi was isolated from the tissue and identified by sequencing the internal transcribed spacer region ITS-1 and the D1-2 fragment of the 28S rDNA gene. Histopathological examination showed fungal hyphae in the internal inflammatory cells layer and within the histocyte-macrophage layer, highly suggestive of deep mycosis. The patient was successfully treated with surgical excision of the cyst. M. romeroi exhibited high MIC values for echinocandin drugs in vitro, but appeared susceptible to newer triazole agents, amphotericin B and terbinafine. This is the first report of a subcutaneous phaeohyphomycotic cyst occurring following the placement of an intravenous cannula. This report highlights the potential role of M. romeroi as an emerging cause of deep, non-mycetomatous infection in immunocompromised patients.

Safety and efficacy of excision and direct closure in acute burns surgery: outcome analysis in a prospective series of 100 patients and a survey of UK burns surgeons' attitudes.

Many burns surgeons avoid excision and direct closure of acute burns owing to concerns over wound dehiscence, scarring and infection. There is no evidence in the literature to support this practice. We present outcomes of a prospective series of 100 patients who underwent excision and direct closure of 138 burns over a 2-year period, along with results from a survey sent to 33 senior burns surgeons to gauge attitudes towards direct closure in burns surgery. 47% of survey respondents never perform direct closure. Dehiscence was cited as the most common concern, followed by hypertrophic scarring (HTS). In our cohort, the superficial dehiscence rate was 12% and the HTS rate was 16%, with no scarring contractures. Patients with healing time greater than 14 days were more likely to develop HTS (p=0.008), as were those with wound dehiscence (p=0.014). Patients undergoing part-grafting in addition to direct closure took significantly longer to heal than those undergoing direct closure alone (p=0.0002), with the donor site or graft delaying healing in the majority. Excision and direct closure of acute burn wounds avoids donor site morbidity and has an acceptable complication rate. It is a safe and effective treatment for full thickness burns in selected cases.

An evaluation, at the 1-year stage, of a 3-year project to introduce practice education facilitators to NHS Tayside and Fife.

As a result of the Scottish Executive Health Department (SEHD) initiative, Facing the Future [Scottish Executive Health Department, 2002. Facing the Future. SEHD, Edinburgh], a need was identified for a group of experienced nurses and midwives to help support students and mentors within practice settings. It was agreed to fund one hundred "G" grade posts across NHS Scotland for an initial period of three years. As a result of this initiative, in 2004 a group of fifteen Practice Education Facilitators (PEFs) were employed by NHS Tayside and NHS Fife in Scotland. Their brief was to maintain and improve learning environments within the practice setting. This paper describes an evaluation of this new role as carried out at key stages within the first year of the project. A combination of focus groups and questionnaires were used, both to analyse the perceptions of the NHS staff that PEFs would be working with and to explore the lived experience of the PEFs during their first year in post. There was a general welcome for the role across all groups. Perceptions varied on the PEF role itself, most staff groups expecting PEFs to work mainly with students. The PEFs, however, saw the main thrust of their work with mentors, their associates and other staff.