British journal of plastic surgery最新文献

Following endorsement of serial halving by the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh this study aimed to determine whether the technique was comparable to the rule of nines in making initial assessments of body surface area burned. Ten ‘casualties’ were made up to represent burn victims (range 6–61%). An external panel of six consultants and one specialist registrar in plastic surgery were invited to assess the simulated casualties. They gave individual and a consensus estimate of the burned areas. One hundred and twenty-five members of local emergency services and military paramedical staff were given a brief video and slide presentation describing either the rule of nines or serial halving method of burn area assessment. These techniques were then used to assess the 10 simulated casualties, giving 1250 estimates of burn surface area. The understanding of both techniques appeared adequate in both test groups. Estimates from serial halving and rule of nines groups differed from the assessments of the external panel. No statistical difference was demonstrated between serial halving and the rule of nines as an initial assessment tool when determining disposal. Serial halving has an inherent weakness when assessing certain sizes of burn. The rule of nines requires that the assessor knows and understands the proportionate areas of the body. The mathematics of percentages and fractions appeared to confuse some assessors.

In this study, we aimed to investigate the efficacy of cell based dressing with living allogenic keratinocytes in diabetic foot patients. To address this issue, the cultured keratinocytes were attached to the microcarriers produced from polyethylene and silica. The microcarriers were then applied to the wounds at 3-day intervals. Forty patients with grade II and III diabetic foot ulcers were included into the study. The patients were randomised into two groups (n=20). The treatment and control groups received cell based dressing and microcarriers kept in culture medium overnight, respectively. The wound size was recorded at 3 days intervals. The wounds were also categorised by a specific scoring system considering the wound contraction, granulation tissue formation, epithelisation and discharge from the wounds. The high score indicates better condition.

The mean reduction of the wound area was 92% in the treatment group and 32% in the control group at the end of the 30 days treatment (p<0.001). When considered the complete healing, the mean number of dressings was 9.2±3.2 in the treatment group whereas it was 16.5±2.3 in the control group (p<0.001). The initial mean score of the treatment and control groups were 2.5 and 2.35, respectively. At the end of the 30th day, the mean score of the treatment group was 17.15±2.7 and of control group was 9.05±3.

Allogenic keratinocyte treatment delivered with microcarriers can make significant contributions to wound healing in diabetic foot patients.

Introduction

Pulsed dye laser (PDL) treatment is based on the principle of selective photothermolysis and is widely considered to be the treatment of choice for a variety of cutaneous vascular lesions.

Objective

To review the indications and outcome of PDL treatment and summarise new developments.

Method

A literature-based study has been conducted entailing the review of publications over the period January 1993–December 2003 using the databases Medline and Cochrane CENTRAL.

Results

The PDL was found to be effective in port wine stain, facial telangiectasia, leg telangiectasia <0.5 mm, scars, hypertrophic scars and ulcerated haemangioma.

Discussion

Essential characteristics of lesions suitable for PDL treatment are discussed and guidelines are presented for future research.

Congenital bilateral brachymetatarsia of the fourth metatarsal bone was treated by osteotomy and bone lengthening using the internal distraction technique. The patient was cosmetically improved. This technique has some advantages over the method of external distraction.

The pulsed dye laser has been the treatment of choice for port wine stains over the past 20 years.

In the past 5 years there has been increasing discussion of the role of other light treatments, such as the intense pulsed light system in the treatment of port wine stains. These systems use high-energy lamps, which emit noncoherent broad-spectrum light. Cut off filters are applied depending on the treatment modality to limit the wavelengths emitted.

We present the results of a 3-year prospective within patient controlled clinical trial using an intense pulsed light system called the Lumina, developed by Lynton Lasers of Cheshire, England.

Our aims and objectives were to assess the effectiveness of the system in the treatment of port wine stains in a human model and to record the optimum treatment parameters and the incidence of side effects.

Following ethical approval 12 subjects were enrolled into the trial. In order to meet the requirements of the local ethics committee these were all adults with port wine stains located in less visible areas of the body.

The results showed that eight of the 12 subjects had some degree of fading of their port wine stain as measured on a percentage scoring system. Of the four who failed to show any response, all had pink port wine stains. It did seem the case that the darker the port wine stain, the better the fading seen. Furthermore, the more distal lesions tended to be less responsive than those situated closer to the head area. However, it is difficult to draw any definitive statistical conclusions due to the small number of patients in the trial.

Vascular access in intravenous drug abusers may become compromised by the repeated injection of toxic substances. In such circumstances abusers are driven by their addiction to seek alternative routes of drug delivery. We report a series of individuals with chronic ulcers, which were cultivated and maintained for the administration of heroin. We advise that practitioners should be wary of granulation tissue being promoted in this way and suggest that the patients' desire for wound healing may be overridden by their addiction and that successful treatment of these wounds is reliant upon cessation of drug abuse and patient compliance. In our experience this is most easily achieved in a multidisciplinary environment.

This is a descriptive analysis of 50 consecutive cases of therapeutic mammaplasty, the use of reduction mammaplasty and radiotherapy to treat breast tumours. Breast cancers may lie within the normal excision site of a recognised mammaplasty method (scenario A) or outside of the expected excision sites (scenario B), then requiring a modified mammaplasty. A third group are central tumours requiring removal of the nipple. This series includes 13 scenario A, 27 scenario B and 10 central tumours. Wise pattern skin incision was used in 29 (58%) and vertical in 14 (28%). Seven different pedicles were employed but inferior (11), superior (9) and superio-medial (19) comprised the majority (78%). In the 27 scenario B cases an extension of the nipple aereolar pedicle was used to fill the tumour defect in 19 (70%) and a secondary pedicle in 8 (30%).

There were no incomplete excisions of invasive tumour but incomplete excision of DCIS requiring mastectomy occurred in 4 (8%) patients. There are no deaths or recurrences to date (mean follow-up 13 months, range 3–32). Complications have occurred in 8 (16%) with a return to theatre for one complication (2%) and the four patients (8%) requiring mastectomy. No patient has had a delay in adjuvant treatment. Cosmetic outcome was deemed good/excellent in 63%, satisfactory in 33%, poor in 4%. Follow-up is restricted to 3–32 months.

Flap neovascularisation is generally believed to make free skin-containing flaps independent of their axial pedicle blood supply. A case of DIEP-flap failure 3 years after transfer is presented in a breast reconstruction patient in whom a lateral breast reduction for symmetry improvement was performed. Causative factors in this patient were the division of the flap pedicle during lateral breast reduction and smoking in the postoperative period. A review of literature is presented and highlights the uniqueness of this case.