Blood-borne viruses: are we taking them seriously? A survey of UK oral and maxillofacial surgeons.

The nature of the work done by oral and maxillofacial surgeons (OMFSs) potentially places them at risk of transmission of blood-borne viruses from patients. We investigated the incidence of exposure to infected blood among OMF surgeons, and whether enough protection is being used. An anonymous postal questionnaire was sent to all OMFS consultants working in the UK in 2008 (n=344) to investigate three areas relating to blood-borne viruses: incidence of surgeons experiencing and reporting exposure to potentially infected blood, their opinions about which patients pose a particular risk, and treatment plans and equipment selected when given two set clinical situations. A total of 148 consultants (43%) responded. Of the 80 respondents (61%) who had been exposed to blood within the last five years, more than two-thirds (n=55) did not always report such incidents. Eighty-five (60%) stated that they considered that all patients posed a risk to the surgeon, and 104 (73%) altered their practice depending on the perceived risk from the individual patient.

A randomized controlled trial on cross-infection control in maxillofacial trauma surgery: a comparison of intermaxillary fixation techniques.

Glove perforations and percutaneous injuries occur commonly during the treatment of facial fractures and reveal the need for safer techniques, especially in intermaxillary fixation. The Rapid IMF device does not use any wires and may provide better cross-infection control than wiring methods. The aim of this study was to test the hypothesis that Rapid IMF is associated with fewer glove perforations/ percutaneous injuries than traditional wiring techniques. The authors carried out a randomized controlled trial which included 120 patients with fractures of the mandible requiring open reduction and fixation. The participants were allocated either to the study group and treated with intraoperative Rapid IMF or to the control group and managed with intraoperative eyelet wire ties. Analysis of the results showed that the Rapid IMF group had significantly fewer glove perforations than the traditional method (0.67 per operation compared with 1.5), (P<0.0001). The incidence of skin-penetrating injuries was the same in both groups (rate 0.02/ procedure). The application of Rapid IMF was significantly faster than wiring (P<0.0001). Minor intraoperative complications were noted in both groups, but more in the Rapid IMF group. Most concerned loosening or fracture of the anchorage ties but the surgical outcome was not affected. Rapid IMF is a safer alternative to wiring methods with significant reduction in glove perforation rates and is quicker to apply than conventional wiring techniques.

Preoperative vascular assessment of the lower limb for harvest of a fibular flap: the views of vascular surgeons in the United Kingdom.

Adequate preoperative vascular assessment of the lower limb is essential before harvesting fibular free flaps to prevent ischaemic complications or failure of the flap. The best method of assessment remains controversial. Clinical examination, conventional angiography, colour flow Doppler, and magnetic resonance angiography have all been advocated. We asked 206 UK vascular surgeons for their opinions on preoperative assessment and potential issues of negligence and 85 (42%) completed the questionnaire. All respondents thought that further imaging should be done in addition to clinical examination, most of whom (n = 70) favoured colour flow Doppler (82%). In addition 75 (88%) considered that the surgeon would be judged to be negligent if clinical examination was the only preoperative assessment. In the light of these findings, we suggest that an objective assessment of the vasculature of the leg should be obtained before a fibular flap is harvested.