The Effect of Electronic Cigarettes on Hand Microcirculation.

PURPOSE: Smoking conventional cigarettes reduces peripheral microcirculation leading to worse outcomes after hand surgery. Patients are increasingly using electronic cigarettes (eCigarettes); however, there is no published research investigating the effects of eCigarettes on hand microcirculation. METHODS: Fifteen healthy subjects with a median age of 26 years were recruited: 7 smokers and 8 nonsmokers. A noninvasive O2C laser Doppler probe measured a baseline control reading at deep (7-mm) and superficial (3-mm) levels. Participants commenced a 5-minute smoking protocol of nonnicotine (0-mg) eCigarettes with continuous microcirculation measurements during smoking and for 20 minutes afterward. This was repeated with nicotine (24-mg) eCigarettes. Readings were averaged over 5-minute periods and standardized as a percentage of baseline. A linear mixed-effects model with an unstructured covariance structure was used to analyze the data. RESULTS: Smokers had a statistically significant reduction in hand microcirculation during and up to 20 minutes after smoking a 24-mg eCigarette. There was a maximum reduction of 77% in superficial flow and 29% in deep flow. After smoking a 0-mg eCigarette, smokers demonstrated an increase in superficial flow of up to 70% with no change in deep flow. Nonsmokers had no statistically significant change in superficial or deep flow after smoking either eCigarette. CONCLUSIONS: A 24-mg eCigarette significantly reduced smokers' hand microcirculation during and after smoking. Microcirculation increased in smokers after inhalation of a 0-mg eCigarette. CLINICAL RELEVANCE: We advise smokers undergoing hand surgery to avoid high-dose eCigarettes and, if necessary, to use 0-mg eCigarettes as an alternative.

Management of a rare, giant multicompartmental lipoma of the hand: a case report and review of the literature.

Lipomas are the commonest benign tumour, made up exclusively of adipose tissue, and can arise anywhere in the body. However, giant lipomas of the hand, defined as >5 cm in diameter, are rare. They have the potential to invade into surrounding areas and cause a multitude of symptoms due to the compression and proximity of underlying structures. We describe a case of a 64-year-old woman who presents with a swelling of the left thenar eminence, associated with numbness and tingling in all fingers. Magnetic resonance imaging and nerve conduction studies confirmed the diagnosis of a lipoma causing median nerve compression. The patient underwent elective surgical excision with good postoperative recovery. The excised lesion, measuring 12 × 7 × 2.4 cm, is one of the largest giant lipomas of the hand reported in literature, and the first to demonstrate invasion from the mid palmar space into both the dorsal sub-aponeurotic space and carpal tunnel.

Limitations to the use of bromelain-based enzymatic debridement (NexoBrid®) for treating diabetic foot burns: a case series of disappointing results.

BACKGROUND: Bromelain-based enzymatic debridement with Nexobrid® (Mediwound) is an alternative to traditional surgical tangential excision of deep dermal and full thickness burns. Early literature suggests that Nexobrid debridement could reduce the number of operations, infection rates, inpatient stay and the necessity for skin grafting to wounds by preserving viable tissue. To our knowledge there are no previous studies reporting the use of NexoBrid for treating burns in patients with established diabetic foot disease. CASE PRESENTATION: We conducted a retrospective case series and identified four patients with diabetic foot burns that were treated with Nexobrid® debridement. All of these patients developed further eschar and deepening of their wounds a few days after NexoBrid was applied, requiring further surgery and skin grafting. CONCLUSIONS: We would recommend judicious use of this new product in patients with diabetic foot wounds.

An interprofessional induction to hand surgery.

BACKGROUND: Hand surgery is a multidisciplinary specialty and health care professionals require effective training. An interprofessional induction for hand trauma co-ordinators (HTCs), core trainees (CTs) and specialty trainees (STs) was designed. The primary aim of our study was to determine any improvement in participants' knowledge. Our secondary aim was to assess participants' responses to the interprofessional aspect of the induction, and to gather general feedback. METHODS: Validated multiple-choice questionnaires (MCQs) were distributed to 18 participants before and after induction. Score improvement was analysed for significance with a Student's t-test. Feedback was obtained with validated questionnaires using Likert-scale answers, Yes/No answers and qualitative free-text answers. RESULTS/FINDINGS: Overall, the MCQ scores significantly improved by 3.8/16 points (p < 0.0001). HTC, CT and ST scores improved by 4.3 points (p < 0.05), 3.8 points (p < 0.0005) and 3.6 points (p < 0.005), respectively. The educational content and presentation of the sessions were rated as 4.44/5 and 4.50/5, respectively. Participants appreciated the interdisciplinary aspect of the induction and thought it improved interprofessional teamworking (83%) and patient care (89%), but needed more time to cover topics. DISCUSSION: Our study shows that our interprofessional induction significantly improved the knowledge of participants from all levels of experience within the MDT, whilst developing interprofessional collaboration to promote safe and effective care for patients. This study is of interest to specialties working within a multidisciplinary team environment. Hand surgery is a multidisciplinary speciality and health care professionals require effective training.

A preoperative marking template for deep inferior epigastric artery perforator flap perforators in breast reconstruction.

Preoperative perforator marking for deep inferior epigastric artery perforator flaps is vital to the success of the procedure in breast reconstruction. Advances in imaging have facilitated accurate identification and preselection of potentially useful perforators. However, the reported imaging accuracy may be lost when preoperatively marking the patient, due to 'mapping errors', as this relies on the use of 2 reported vectors from a landmark such as the umbilicus. Observation errors have been encountered where inaccurate perforator vector measurements have been reported in relation to the umbilicus. Transcription errors have been noted where confusing and wordy reports have been typed or where incorrect units have been given (millimetres vs. centimetres). Interpretation errors have also occurred when using the report for preoperative marking. Furthermore, the marking process may be unnecessarily time-consuming. We describe a bespoke template, created using an individual computed tomography angiography image, that increases the efficiency and accuracy of preoperative marking. The template is created to scale, is individually tailored to the patient, and is particularly useful in cases where multiple potential suitable perforators exist.