ABSTRACT
INTRODUCTION: We present the case of an overlooked scalp laceration in an 81-year-old lady who presented with polytrauma following a fall down stairs. Complications that developed required more extensive treatment compared to what would have sufficed with early identification. PRESENTATION OF CASE: Imaging on admission to hospital showed multiple vertebrae and rib fractures as well as a large cranial subcutaneous haematoma with no intracerebral bleed. Before the laceration was identified, the patient developed acute anaemia requiring transfusion. Continued reduction in haemoglobin levels called for a more thorough examination of the scalp. Investigation, following copious irrigation, revealed a large laceration. The presence of infection and necrotic tissue necessitated a general anaesthetic for debridement and closure. DISSCUSSION: Diagnostic errors are more common in patients presenting with multiple or severe injuries. Initial management in trauma cases should focus on more evident or life threatening injuries However, it is important that reflections and recommendations are continually made to reduce diagnostic errors, which are higher in polytraumatised patients. Various factors including haemodynamic instability and patient positioning added to the elusive nature of this wound. Adequate examination of lacerations requires thorough cleaning as coagulated blood and other material may obscure findings. This is particularly important in scalp lacerations where the overlying hair can form a barrier that is effective at hiding the wound edges. CONCLUSION: This case highlights the importance of a thorough secondary survey; an effective examination technique would have avoided the need for extensive treatment to manage the sequelae of the missed scalp laceration.
ABSTRACT
INTRODUCTION: The worldwide obesity epidemic is creating new challenges for surgeons involved in breast reconstruction. This systematic review aims to summarise the research available in order to determine the surgical and medical complications, the duration of surgery and post-operative hospital stay and the likelihood of reoperation in each of the different techniques of breast reconstruction in women with obesity. To our knowledge, no systematic review is currently available that assesses the impact of obesity on breast reconstruction outcomes. METHODS AND ANALYSIS: Electronic searches will be conducted on Cochrane, PUBMED and EMBASE, from their inception to 1 June 2016. All cohort studies, case series, randomised controlled trials, and case-control studies on women undergoing breast reconstruction post mastectomy for oncological reasons will be included. Articles must mention at least one of the primary outcomes of interest. Full exclusion and inclusion criteria are described within this protocol. Primary and secondary outcomes are described within this protocol. The search strategy, described within this protocol, aims to identify all articles on "obesity and breast reconstruction." DISCUSSION: This paper outlines the study protocol for a systematic literature review that will identify and summarise currently available evidence on the effectiveness and complications of breast reconstructive procedures in women with a BMI >30 kg/m2. This review aims to provide an overview of the evidence in order to create a guide for healthcare professionals involved in the breast reconstruction of obese women. DISSEMINATION: This review will be published in a peer-reviewed journal and will be presented at various national and international conferences.
ABSTRACT
Body dysmorphic disorder (BDD) is a somatoform disorder characterised by a distressing obsession with an imagined or slight appearance defect, which can significantly impair normal day-to-day functioning. Patients with BDD often first present, and are hence diagnosed, in cosmetic surgery settings. Several studies have investigated the prevalence rate of BDD in the general population or have done so for patients referring to cosmetic medical centers. To date, however, no review has been undertaken to compare the prevalence in the general community versus in a cosmetic surgery setting. Despite the lack of such a review it is a commonly held belief that BDD is more common in patients seeking cosmetic surgery. The current study aims to review the available literature in order to investigate whether BDD is indeed more prevalent in patients requesting cosmetic surgery, and if that is the case, to provide possible reasons for the difference in prevalence. In addition this review provides evidence on the effectiveness of cosmetic surgery as a treatment of BDD.
