Patients' perception of medical photography.

INTRODUCTION: With the advent of digital medical photography, a balance between technological possibility and ethical acceptability is necessary. An understanding of patients' perception is vital in maintaining a healthy doctor-patient relationship and the avoidance of unnecessary medico-legal consequences. To explore this, an anonymous patient questionnaire survey was conducted. METHODS: Ethically approved questionnaires were distributed in our plastic surgery clinics. The questionnaires examine patients' acceptability of the use of identifiable and non-identifiable photography for different purposes including teaching, presentation, publication and internet. Patients' preferences on equipment used and who should view their images were also recorded. 205 completed questionnaires were analysed and statistically assessed. RESULTS: There was a low level of acceptability to the use of personal cameras (16%) and phones (12%) compared to hospital equipment (75% p<0.001). The use of non-identifiable photographs was more acceptable for all purposes (p<0.001). Electronic distribution was less favoured (p<0.001). Patients agreed to have their photographs used by treating doctors (98%), other doctors (74%), for student teaching (82%) or patient education (88%). CONCLUSION: Medical photography is acceptable to most patients. Appropriate consent and equipment would maximise patient compliance and clinical benefits. Our discussion with medical professional and defence organisation provide a portrait of current perspectives.

Flucloxacillin reduces stiffness following flexor tendon repair.

To determine the benefit of antibiotic prophylaxis on postoperative mobility in flexor tendon repairs, case notes of 72 flexor tendon injuries in twenty four patients were analyzed retrospectively (2001-2003). Only patients with non-contaminated injuries from sharp instruments in flexor zone 2 were included in the study; 57% were male, average age was 31 years, and 24% were smokers. The majority of injuries were caused by metal blades (45%). Most tendons were repaired with modified Kessler technique (69%). Twenty-five percent received intravenous flucloxacillin or co-amoxiclav perioperatively. Reduced total active motion (TAM, found in 25% of patients more than 7 weeks after surgical repair) significantly complicated patients without perioperative intravenous flucloxacillin cover. The use of intravenous perioperative flucloxacillin is a plausible adjunct in surgery to prevent postoperatively reduced mobility.

Breast reduction and smoking.

To investigate the influence of smoking on the occurrence of complications in patients undergoing breast reduction, a retrospective case note study was performed. Seventy-one patients who had 118 reduction mammoplasties between April 2001 and March 2002 were analyzed; 15.5% (11/71) of all patients suffered a complication. Ten complications were of infective nature. There was no case of partial or total nipple necrosis. Factors like past medical history, breast history, drug history, age, body weight, and resection weight did not influence the development of complications (P > 0.4, respectively). Smoking, however, was found to be a significant risk (P < 0.05). The risk to develop complications after reduction mammoplasty was calculated to be more than 3 times as high when compared with nonsmokers.