An electronic operation note proforma improves the quality of operation notes in burns surgery.

BACKGROUND: An Operation Note should provide a comprehensive account of the details of a surgical procedure performed and document clinically relevant events which occur throughout the procedure. The Royal College of Surgeons of England, in 2014, updated guidelines on specific criteria to be included in operation notes. Standardisation using procedure-specific operation notes has been shown to significantly improve adherence to these guidelines. The aim of this study was to evaluate the quality of operation notes in the Irish National Burns Unit before and after the design and implementation of an electronic patient record and the subsequent introduction of an operation template and a burns surgery specific checklist, within the electronic system. METHODS: A 30-point checklist was designed based on existing sources. Operation notes prior to and following the adoption of a electronic-based operation note were analysed, and then reanalysed following the introduction of a procedure-specific operation note. RESULTS: Ninety-three operation notes were included for analysis. An electronic operation record significantly improved the quality of documentation within our unit. The subsequent procedure specific operation note had a significant improvement across all areas and achieved 100% compliance in many categories. CONCLUSIONS: The use of an electronic patient record to document a patient's procedure has been shown to significantly improve the quality of documentation. One could expect this to result in an improved patient hand-over and subsequent episode of care. We highlight a number of initial pit-falls that others may avoid in their implementation of a digital record.

Pedicled sural flaps versus free anterolateral thigh flaps in reconstruction of dorsal foot and ankle defects in children: a systematic review.

BACKGROUND: This systematic review compared free anterolateral thigh (ALT) flaps versus pedicled distally based sural artery (DBSA) flaps for reconstruction of soft tissue defects of dorsal foot and ankle in children. METHODS: A systematic literature search was performed to identify cases where an ALT or DBSA was used to reconstruct the dorsal foot in children. A total of 19 articles were included in the systematic review. RESULTS: Eighty-three patients underwent an ALT reconstruction and 138 patients underwent a DBSA reconstruction. Patients who had a DBSA were more likely to require grafting of the donor site (P<0.001). The size of ALT flaps was significantly larger than DBSA flaps (P=0.002). Subsequent flap thinning was required in 30% of patients after ALT and 12% of patients after DBSA reconstruction (P<0.001). Complications occurred in 11.6% of DBSA and 8.4% of ALT flaps (8.4%). CONCLUSIONS: Both flaps are valid options in reconstructing pediatric foot and ankle defects. Each flap has advantages and disadvantages as discussed in this review article. In general for larger defects, an ALT flap was used. Flap choice should be based on the size of the defect.

Cyanide poisoning in inhalation injuries.

Cyanide gas forms during the combustion of synthetic polymers and should be considered in patients presenting with inhalation injuries. A persistently high lactate following adequate resuscitation may be an indicator of cyanide exposure. As cyanide poisoning can be rapidly fatal, prompt recognition and treatment of this condition is vital.

Thrombosed capillary network in a full-thickness burn.

Full-thickness burns are associated with cardinal clinical features. The recognition of these signs has important implications for immediate and future care of such burns.

Staphylococcal Osteomyelitis: Disease Progression, Treatment Challenges, and Future Directions.

Osteomyelitis is an inflammatory bone disease that is caused by an infecting microorganism and leads to progressive bone destruction and loss. The most common causative species are the usually commensal staphylococci, with Staphylococcus aureus and Staphylococcus epidermidis responsible for the majority of cases. Staphylococcal infections are becoming an increasing global concern, partially due to the resistance mechanisms developed by staphylococci to evade the host immune system and antibiotic treatment. In addition to the ability of staphylococci to withstand treatment, surgical intervention in an effort to remove necrotic and infected bone further exacerbates patient impairment. Despite the advances in current health care, osteomyelitis is now a major clinical challenge, with recurrent and persistent infections occurring in approximately 40% of patients. This review aims to provide information about staphylococcus-induced bone infection, covering the clinical presentation and diagnosis of osteomyelitis, pathophysiology and complications of osteomyelitis, and future avenues that are being explored to treat osteomyelitis.

Experiences with pins and rubber band traction in the treatment of proximal interphalangeal joint contracture.

BACKGROUND: Proximal interphalangeal joint (PIPJ) contracture is a difficult problem to treat regardless of etiology. Although numerous interventions have been recommended, published results are mediocre at best. OBJECTIVE: The authors describe their experience and results of using a modification of pins and rubber band traction (PRBT) - applying a dynamic extension apparatus to a contracted PIPJ using the constant traction force in a stretched rubber (elastic) band. METHOD: A retrospective review of patients treated with this method was performed, and the results are presented. The technique itself is described, and clinical photographs illustrate the method. RESULTS: Mean PIPJ flexion contracture before PRBT was 82° (range 60° to 110°). The full correction of eight contracted PIPJs in seven patients was achieved, in a mean of 17.8 days (range 14 to 31 days). At one month postremoval of PRBT, the mean PIPJ flexion contracture was 22.8° (range 0° to 46°). DISCUSSION: The method is compared with previously described methods of PIPJ contracture correction, whether surgical or splinting; the latter may be static, dynamic or a combination of the two. The results of previously published studies are discussed and compared with the method described. CONCLUSION: The present method is a powerful and effective simplification of a previously described method of correcting PIPJ contractures. This technique is simple, 'low-tech' and can be applied under local anesthetic; the authors believe it offers a useful adjunct to surgical release.

HISTORIQUE: Quelle qu'en soit l'étiologie, la contracture de l'articulation interphalangienne proximale (AIPP) est difficile à traiter. Même si de nombreuses interventions sont recommandées, les résultats publiés sont pour le moins médiocres. OBJECTIF: Les auteurs décrivent leur expérience et les résultats de l'utilisation d'une traction par des tiges et des ancres (TTA), soit l'application d'un appareil d'extension dynamique sur une AIPP contractée à l'aide d'une force de traction constante par une bande élastique étirée. MÉTHODOLOGIE: Les auteurs présentent une analyse rétrospective des patients traités par cette méthode et les résultats du traitement. Ils décrivent la technique et l'illustrent pas des photos cliniques. RÉSULTATS: La flexion moyenne de la contracture de l'AIPP avant la TTA était de 82 ° (plage de 60 ° à 110 °). Huit AIPP contractées ont été complètement corrigées chez sept patients, sur une période moyenne de 17,8 jours (plage de 14 à 31 jours). Un mois après le retrait de la TTA, la flexion moyenne de la contracture de l'AIPP était de 22,8 ° (plage de 0 ° à 46 °). EXPOSÉ: La méthode est comparée à des méthodes par chirurgie ou attelle déjà décrites pour corriger la contracture de l'AIPP. L'attelle peut être statique, dynamique ou combinée. Les résultats d'études déjà publiées sont exposés et comparés à la méthode décrite. CONCLUSION: La présente méthode simplifie avec puissance et efficacité un moyen décrit antérieurement pour corriger les contractures de l'AIPP. Elle est simple, peu complexe et peut être effectuée sous anesthésie locale. Les auteurs sont d'avis qu'elle constitue un ajout utile à la libération chirurgicale.

Trineural injury to the right hand after domestic electrocution.

Electrocution injuries account for a significant amount of burns unit admissions each year, and can be fatal. These injuries are divided into high-voltage (over 1000 volts) and low-voltage (less than 1000 volts) injuries, with lightning strikes (greater than 100 million volts) considered separately. Although the majority of electrocution injuries are of low voltage, most of the published reports concern industrial/high-voltage and lightning injuries. This disparity may trivialize low-voltage injuries in the minds of clinicians. We report a rare case of trineural (median, ulnar, and radial) injury in an upper limb after a low-voltage electrocution, and discuss the pathogenesis, investigation, and treatment of these injuries.

Attitudes to cadaveric organ donation in Irish preclinical medical students.

There is a worldwide shortage of organs for transplantation. It has been shown that the attitude of healthcare professionals can improve the rates of organ donation, and that educational programs aimed at improving both attitudes and knowledge base of professionals can have positive outcomes. Although there has been research carried out on this topic, there has been none in Ireland. Anatomy dissection can be a stressor to medical students-we investigate the attitudes of Irish students to organ donation and how they change with exposure to anatomy dissection. A questionnaire was administered to first year students in the School of Medicine in University College Dublin, Ireland, three times over a nine-week period at the commencement of classes in an academic year. The attitudes of the students were positive throughout regarding organ donation by a stranger, a family member, or themselves. There was, however, a significant decrease in support for the donation of a family member's organs in a minority of students. Irish students' attitudes to postmortem organ donation are positive and are not changed by exposure to the dissecting room. There is support for the donation of organs, and willingness among students to donate their own organs and support donation by family members.

Attitudes to anatomy dissection in an Irish medical school.

Many studies around the world have looked at the stresses placed on medical students by cadaveric dissection. Although these studies have linked the use of cadavers in medical teaching to stress, some investigations have suggested an association with severe psychological stress and even post-traumatic stress disorder. This study assessed the attitudes of medical and biomedical sciences students in an Irish medical school towards cadaveric dissection by recording, through a questionnaire, their perceptions and experience before initial exposure to dissection and subsequently examining their attitudes after the first dissection and after 9 weeks. Student attitudes towards the dissecting room remained consistently positive for the duration of the study with only a minority of respondents reporting negative symptoms. Pre-existing attitudes to the idea of dissection were unaffected by exposure and subsequent continuous experience of dissection. The majority of students in this study did not find the dissecting room experience stressful, and considered time spent in the dissecting room valuable. However, the proportion of students with negative experiences in the dissecting room was higher than has been reported in previous studies. Many respondents felt they could be better prepared for the dissecting room experience, indicating an increasing requirement for effective preparatory programmes.

Student attitudes to whole body donation are influenced by dissection.

Given the important role that anatomical dissection plays in the shaping of medical student attitudes to life and death, these attitudes have not been evaluated in the context of whole body donation for medical science. First year students of anatomy in an Irish university medical school were surveyed by questionnaire before and after the initial dissection and again after 9 weeks of anatomical dissection. Analysis of student responses to the idea of whole body donation by an unrelated stranger, a family member, or by the respondent showed that a priori attitudes to donation by a stranger did not change with exposure to dissection. However, student opposition to donation by a family member was evident immediately after the initial dissection and was sustained throughout the duration of this study. Support for the idea of donating their bodies to medical science decreased significantly among respondents after exposure to dissection (31.5% before dissection, 19.6% after dissecting for 9 weeks) but not to levels reported in the general population in other studies. This study demonstrates that where dissection forms a part of anatomy teaching, students expect to learn anatomy by dissecting donors whom they do not know. As a potential donor population, students are reluctant to become emotionally involved in the donation process and are unwilling to become donors themselves.