Outcome of erbium:yttrium aluminium garnet laser resurfacing treatments.

Erbium:yttrium aluminium garnet (erbium:YAG) laser treatment was used to resurface skin abnormalities in patients suffering from conditions that included epidermal naevi, tuberous sclerosis, angiofibromata, neurofibromatosis, and scarring caused by acne or other means. Patients completed self-report questionnaires before their first laser test patch session, and again approximately 4 months after one treatment, so that its success could be evaluated from the patient's perspective. Disability and distress were quantified with the University of York Health Measurement Questionnaire (HMQ). Satisfaction with appearance was measured with a specifically designed Salisbury Appearance Scale (SAS) questionnaire. Pretreatment questionnaires were completed by 108 (HMQ) and 80 (SAS) patients. Thirty-six (HMQ) and 22 (SAS) patients completed a full treatment during the study period. Some patients had a test patch only during the study period. Others decided against further treatment after the test patch. Control SAS questionnaires were completed by 29 subjects on two occasions and showed no change over time. There was a significant improvement in patient satisfaction with appearance (SAS), but there was no significant difference in the disability and distress (HMQ) after erbium:YAG resurfacing.

Towards performance measurement in reconstructive surgery: a multicentre pilot study of free and pedicled flap procedures.

OBJECTIVES: To pilot the acceptability and feasibility of clinical audit in free and pedicled flap reconstruction. To establish a baseline flap failure rate in participating units, so that a sample size calculation could be performed for future national audit. METHODS: A proforma was piloted over a 3-month period in four participating units, during which time data on 93 reconstructive procedures involving free and pedicled flaps was collected. The patients included those where large transfers of tissue were required such as for coverage of grade IIIb compound tibial fractures and breast reconstruction after mastectomy, and also smaller flap transfers such as after skin cancer excision. RESULTS: The proforma was found to be acceptable to clinicians and the feasibility of the data collection process was established. Overall there was a total flap survival of 89% and secondary operations to the donor or recipient sites were required in 11% of patients. CONCLUSIONS: This study demonstrates the feasibility of comparative audit for free and pedicled flap procedures using the methods proposed. Based on the incidence of flap failure observed in this pilot study, at least 18 months of prospective data collection on consecutive patients is required to fulfil the statistical requirements of comparative audit. The establishment of a routinely collected minimum dataset is proposed as one means of meeting these requirements.

Dynamic external fixation for complex intraarticular phalangeal fractures.

Intraarticular phalangeal fractures are difficult to treat. The advantages of using dynamic external fixation devices include distraction of impacted fracture fragments and reduction in joint stiffness by allowing early joint mobilization. Previous reports have concentrated on pilon fractures and dorsal fracture dislocations affecting the proximal interphalangeal joint. We report our experience using a dynamic external spring fixator in the management of 15 patients with a variety of fracture patterns affecting the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. In three cases the device spanned two adjacent joints. Long-term follow-up has shown excellent range of joint movement and no major complications. We consider that this device is an effective tool in the management of a range on complex intraarticular phalangeal fractures.

Basal cell carcinomata in port wine stains.

The development of basal cell carcinoma (BCC) in a port wine stain is rare and the aetiology of these malignancies in this situation is the subject of some debate. Early treatment of port wine stains with ionising radiation has been implicated in the development of BCC. The use of the argon laser has not been implicated. We present four cases of BCC in port wine stains, one previously treated with an argon laser, and discuss the possible aetiological factors.

Functional recovery in cancer rehabilitation.

OBJECTIVE: To assess the impact of inpatient rehabilitation on the motor and cognitive functional status of cancer patients, and to determine whether cancer diagnosis, rehabilitation impairment, physician-determined rehabilitation goals, and active cytotoxic treatment affect the magnitude of functional improvement. DESIGN AND SETTING: A retrospective, case series of patients with an oncology diagnosis undergoing inpatient rehabilitation at a rehabilitation hospital. PARTICIPANTS: A sample of 200 patients admitted for rehabilitation services due to disability resulting from impairments caused by cancer or its treatment. INTERVENTION: Comprehensive multidisciplinary inpatient rehabilitation. OUTCOME MEASURES: Function status was measured using the motor and cognitive measures of the Functional Independence Measure. RESULTS: All patients made significant gains in motor function regardless of diagnostic group, rehabilitation impairment group, rehabilitation goal group, and cytotoxic treatment status. The magnitude of motor function gain was not equivalent across all impairments and rehabilitation goals. Significant gains in cognitive function were made by all patients except those with intracranial neoplasms, central nervous system dysfunction, and palliative rehabilitation goals. CONCLUSION: Inpatient rehabilitation can improve both motor and cognitive function in patients with disability resulting from impairments caused by cancer or its treatment.

MRI scan diagnosis of trilucent breast implant rupture.

The authors present the case report of a patient who had undergone a latissimus dorsi breast reconstruction plus Trilucent implant. This patient later presented with discomfort in the breast and an MRI scan diagnosed rupture of the implant and also revealed a fluid level within the implant. These findings were confirmed at exploration and were found to be caused by separation of the contents into a serous layer and a lipid layer.