Thromboembolic prophylaxis in plastic surgery a 12-year follow up in the UK.

Potentially fatal thromboembolic events prevail post-operatively despite the widespread availability of proven methods of prophylaxis. In 1992 Dujon et al published an article which reviewed thromboembolic prophylaxis methods of Consultant Plastic Surgeons in the UK and Ireland. Our follow up study surveyed all current Consultant B.A.P.S members using a modified postal questionnaire to assess practice nationwide. Our conclusions were drawn from comparisons made between the two populations some twelve years apart. Our results show a dramatic change from the previous findings. Since 1992 86% of respondents have developed a set prophylaxis protocol (compared to 19%). The use of low molecular weight heparin has drastically increased by 24% to 76%, the use of flow-tron boots (or similar) has increased by 22% to 68%, the use of TED stockings has increased by 12% to 83%, the use of multi-modality prophylaxis has increased by 27% to 79% Our results demonstrate a definite shift towards multi-modal thromboembolic prophylaxis, possibly due to increased awareness of available technologies and subsequent reduction in costs.

Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.

BACKGROUND: The aim was to determine the effects of bilateral reduction mammaplasty on quality of life and psychosocial functioning in women with mammary hypertrophy. METHODS: Seventy-three women who were referred to either the Hull Breast Unit or Hull Plastic and Reconstructive Surgery Unit were randomized to early or delayed surgery. Both groups had quality of life and psychosocial assessment. Each group underwent two sets of tests. Women who had early bilateral breast reduction were tested before and at 4 months after surgery, whereas those in the control group were tested at the time of randomization and 4 months later, before undergoing surgery. RESULTS: All 73 women completed the study. Mean age was 39 years, and the two groups were well matched for age, body mass index and breast dimension. There were highly significant differences between groups in scores measured on the Functional Assessment of Non-Life Threatening Conditions version 4, EuroQoL, and both mental and physical scales of Short Form 36 (P < 0.001). The Eysenck Personality Questionnaire-Revised demonstrated a statistically significant increase in extroversion and emotional stability in the early treatment group. CONCLUSION: Reduction mammaplasty significantly improved quality of life, and increased extroversion and emotional stability.

Body contouring by combined abdominoplasty and medial vertical thigh reduction: experience of 14 cases.

The common perception of beauty in the human body has shown a dramatic change over the past few decades culminating in a preoccupation not only with body weight, but also with body image. Obesity is becoming prevalent in our society, and yet generalised redundancy of skin following massive weight reduction can also be an affliction. Localised fat deposits in one or more regions of the trunk, upper arms and thighs are common and are virtually impossible to correct by diet, weight loss or exercise. Excision of the excess pendulous skin and/or the localised fat deposits are able to reduce or even eliminate the physical problems associated with the condition and contribute significantly to patient self-esteem. These procedures are usually multiple and extensive. Combining and reducing the number of such procedures while obtaining optimal results would be most beneficial to both the surgeon and the patient. We report our experience of 14 patients who underwent body contouring operations using combined abdominoplasty and medial thigh reduction with analysis of the results and discussion of the requirements and the advantages of the technique.

Subcutaneous metallic mercury injection of the hand.

Poisoning by subcutaneous metallic mercury is rare and usually accidental. Although it does not carry the same risks as mercury-vapour intoxication, it may still cause destructive early and late local reactions. Two deaths resulting from subcutaneous mercury injection have been reported in the literature. We present a case of accidental subcutaneous injection of mercury in the hand and discuss its management with a review of the literature.

Absorbable versus non-absorbable suture in carpal tunnel decompression.

This randomised prospective clinical study compared the use of an absorbable suture (subcuticular 4:0 polyglactin 910) and a non-absorbable suture (5:0 monofilament polypropylene) for elective carpal tunnel decompression wound closure. An increased perception of pain was reported by the patients in the polypropylene (Prolene) group. At the 6-week assessment, there was a higher level of residual wound inflammation in the polyglactin 910 (Vicryl) group.

Anabolic steroid accelerated multicompartment syndrome following trauma.

The case is reported of a 23 year old male body builder who was involved in a road traffic accident after taking anabolic steroids. The resulting trauma caused a severe life threatening acute multicompartment syndrome resulting in the need for urgent multiple fasciotomies.

Endoscopically assisted gracilis harvest for use as a free and pedicled flap.

Endoscopic assistance in soft tissue surgery may prove to greatly aid in the improvement of cosmesis and reduction of morbidity in certain procedures. The scar produced from open gracilis harvest is the most common complaint following surgery. We present five cases of endoscopically assisted gracilis harvest for use as a neosphincter and in foot reconstruction. The operative technique is described.

Abdominoplasty following vertical banded gastroplasty for morbid obesity.

We describe 15 patients who underwent abdominoplasty following vertical banded gastroplasty for morbid obesity between 1991 and 1994. Vertical banded gastroplasty was performed (by CMSR) on patients with a Body Mass Index greater than 39. Following this, the patients lost weight rapidly, leading to excess folds of skin and fat on the abdomen, arms and thighs, and were referred for plastic surgery when their weight had stabilised. After abdominoplasty, the Body Mass Indices of all the patients decreased to an acceptable range. Because vertical banded gastroplasty causes little long-term metabolic or nutritional disturbance, the abdominal skin could be undermined up to the costal margin and the umbilicus re-sited without major necrosis of the abdominal wall or umbilicus. All patients received prophylactic low dose heparin perioperatively until early ambulation. Prophylactic antibiotics were not used but there were no major wound infections. Patients were reviewed up to 12 months after abdominoplasty and were satisfied with the results. Abdominoplasty following vertical banded gastroplasty for morbid obesity safely provides acceptable cosmetic results.

Cica-Care gel sheeting in the management of hypertrophic scarring.

A prospective, controlled clinical trial was undertaken to assess the efficacy and safety of two types of silicone gel, Silastic Gel Sheeting (SGS) and Cica-Care (CC), in the management of hypertrophic scars. Forty-two patients were randomly assigned to SGS and CC groups and their hypertrophic scars were divided into treated and control areas. Extensometric measurements were made at monthly intervals for 6 months and significant improvement of the treated areas relative to the control areas was observed. The two gels were not significantly different in efficacy or safety, but CC, being more adhesive and more comfortable than SGS, has advantages in ease of use and patient acceptability.

Thromboembolic prophylaxis in plastic surgery: an appraisal.

A survey by questionnaire was conducted amongst consultant plastic surgeons in the UK: 54 replies were received (44% response rate). Three consultants (5.5%) never used any form of DVT prophylaxis. The other 51 (94%) used some form of prophylaxis in at-risk patients. The methods used were found to be diverse. Ten respondents belonged to units with fixed policies for prophylaxis. A controlled trial is suggested to provide statistical evidence of the need for thromboembolic prophylaxis among plastic surgical patients. We believe there is a need for units to develop fixed protocols for the prevention of thromboembolism in at-risk patients.

Type III tibial fractures in the elderly: results of 23 fractures in 20 patients.

A series of 23 type III fractures of the tibia in 20 elderly patients (over 60 years of age) presenting for combined plastic and orthopaedic surgical management over a period of 15 years are reviewed. Overall limb salvage was 53 per cent, with an average inpatient duration not significantly different from that for amputation, suggesting that an age of over 60 years is not necessarily a contraindication to attempts at limb salvage in type III injuries.