Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm.

ABSTRACT: Abdominal compartment syndrome is a serious potential complication of burn injury, and carries high morbidity and mortality. Although there are generalised published guidelines on managing the condition, to date no management algorithm has yet been published tailored specifically to the burn injury patient. We set out to examine the literature on the subject in order to produce an evidence based management guideline, with the aim of improving outcomes for these patients. The guideline covers early detection and assessment of the condition as well as optimum medical, surgical and postoperative management. We believe that this guideline provides a much needed benchmark for managing burns patients with raised intra-abdominal pressure, as well as providing a template for further research and improvements in care.

Orthoplastics, tariffs and the reality of providing complex fracture care.

INTRODUCTION: The United Kingdom (UK) Major Trauma Network has encouraged cohorting of significantly injured patients with specific injury patterns. Complex injuries to the limbs is a key area of this patient population. Funding and clinician resource allocation, have not been appropriately adjusted to take account of this approach. We assessed the orthoplastic trauma workload in our unit over a 12 month period, taking into account the resource burden of each admission in comparison to the funding received. MATERIALS AND METHODS: The details of admissions requiring orthoplastic care over the period from February 2017-February 2018 were extracted from hospital records. Data regarding patient demographics, admission length, procedures and complications was analysed. Additional data regarding time spent in theatre was obtained from computerised records, as well as detailed coding data regarding clinical events coded for and funding received for the admission. RESULTS: 24 patients were identified as meeting the criteria for inclusion in this study. Mean length of stay was 23 days (1-98 days) and theatre time 386 min (15-842 min). Average payment per admission was £14,497 (£593-£86,245). CONCLUSION: Tariff payments barely cover the cost of a hospital bed and theatre time. Materials costs, as well as the additional costs associated with providing a high quality specialist service mean that our orthoplastic service is currently being run at a significant loss. The benefits for patients in having a well-established orthoplastic unit are numerous and well documented. This study provides evidence to support negotiation for a tariff uplift to allow ongoing provision of a high quality orthoplastic service without detriment to hospital budgets.

How Does Volume of Resection Relate to Symptom Relief for Reduction Mammaplasty Patients?

BACKGROUND: Reduction mammaplasty surgery is well known to produce improvement in a wide range of symptoms associated with macromastia. Health care insurers frequently stipulate a minimum resection volume to qualify for coverage, limiting access to surgery for many. The authors aimed to identify whether small volume resections do produce symptomatic improvement, comparing preoperative and postoperative experience of symptoms across a range of tissue resection volumes. METHODS: Reduction mammaplasty patients were given a custom-designed questionnaire at routine postoperative follow-up appointments, asking them to rate their preoperative and postoperative experience of 9 symptoms related to macromastia. Results were compiled and analyzed alongside data from patient case notes. Of 661 patients identified as being eligible for inclusion in the study, 410 had sufficiently complete data to proceed to statistical analysis. Patients were divided into 6 groups based on volume of breast tissue resected. A Schnur sliding scale percentile was also calculated for all patients. Statistical analysis of preoperative symptom prevalence and postoperative symptom change was carried out. Further analysis to examine for evidence of trend in symptom improvement across groups was implemented using the Jonckheere-Terpstra test for ordered alternatives. RESULTS: Patients who go on to have larger volumes of breast tissue resected were found to experience back pain, shoulder grooves, breast pain, rashes under the breast, exercise intolerance, and poor posture more frequently than those who go on to have smaller resections (P < 0.0005 for all). However, across the range of resection volumes, preoperatively symptomatic patients experienced significant improvement in several symptoms. Results suggested that a larger resection volume may correspond with greater improvement in back pain, neck pain, and poor posture. CONCLUSIONS: We found that reduction mammaplasty has a positive impact on a range of symptoms, even with lower volume resections and regardless of body surface area-calculated adjustments. This adds further weight to the argument that patients should not be denied access to the surgery based on arbitrary volume restrictions. We advocate freedom for the surgeon to make a decision on potential benefits of surgery based around the needs of each individual patient.

Penetrating facial injury with an "Airsoft" pellet: a case report.

Airsoft is a recreational combat sport that originated in Japan in the 1970s and is currently increasing in popularity in the UK. Participants use air or electrically powered weapons to fire small plastic pellets at a controlled pressure. UK law strictly regulates the maximum muzzle velocity and the type of ammunition used in these weapons. A search of published papers found several reports of penetrating ocular injuries caused by Airsoft pellets, but no reports of penetrating injuries to other areas of the body. We report the case of a 25-year-old man who sustained a penetrating injury to the cheek after being shot with an Airsoft weapon.