RESUMEN
Severe malnutrition secondary to anorexia nervosa results in deeper burns and significantly impacts wound healing, which represents a major challenge to burn management. The use of acellular dermal matrices, such as biodegradable temporizing matrix (BTM), is a valuable tool to overcome the surgical limitations. We describe a case of a 36-year-old female with a background of anorexia nervosa (body mass index of 12.3) presenting with a 30% total burns surface area (TBSA) burn. All of her burns were excised down to fascia due to the absence of subcutaneous fat. Her thin skin and depleted nutritional status significantly impacted reconstructive options. BTM was utilized to create a neodermis and provide adequate time to optimize the nutritional status before autologous skin resurfacing 3 weeks later, which yielded robust coverage with minimal donor site morbidity. Despite initial surgical and nutritional challenges, excellent outcomes were achieved in terms of wound healing, scar contractures and mobility.
RESUMEN
The announcement of the COVID-19 pandemic in March 2020 had a huge impact on surgical practice in the UK. Many surgical trainees were redeployed to areas within the hospital to provide additional cover during this time. Providing adequate well-being and support to trainees is imperative during such times of hardship.18 plastic surgery junior doctors were redeployed to either intensive care units, emergency departments or medical wards during the period of intervention. A 2-3 weekly quantitative survey was completed by trainees which aimed to explore rates of anxiety, depression and coping during the first peak of the pandemic. A 'COVID-19 Care Package' was provided and regular interactions with the parent team was encouraged via the online platform of Zoom to support surgical junior doctors.The average anxiety score for trainees exceeded that regarded as 'normal' as predicted by the Hospital Anxiety and Depression Scale. Core surgical-level trainees were found to show higher scores of anxiety and depression throughout the course of project as compared with their senior specialty registrar counterparts. 43.8% of junior doctors reported greater levels of stress since the announcement of the pandemic. 81% of junior doctors stated they would value regular check-ins with work colleagues during difficult times.Providing a strong support system for trainees is vital to ensure doctors are not overwhelmed during potentially volatile times in their careers. The use of psychological monitoring tools to guide the implementation of appropriate levels of support for individuals could aid in enhanced junior doctor well-being and support. Feedback from surveys during this time of study suggests that surgical trainees agree that contact with their parent team and colleagues has a positive impact on their well-being and trainees value regular 'check-ins' with their colleagues on a monthly basis.
