Bespoke regional blocks for axillary sentinel node biopsy.

INTRODUCTION: Axillary sentinel node biopsy for melanoma is routinely performed under general anaesthesia. Emerging evidence has shown general anaesthetics are associated with increased mortality in the context of the COVID-19 pandemic. In the interest of patient safety, we have designed a series of bespoke axillary regional blocks enabling surgeons to remove nodes up to and including level III without the need for a general anaesthetic. The aim of this study was to assess the feasibility of performing axillary sentinel node biopsy under such blocks. METHODS: Approval was granted by the Joint Study Review Committee on behalf of the Research and Ethics Department. Ten consecutive patients having axillary sentinel node biopsy for melanoma were included in this prospective study. Patients completed a Quality of Recovery-15 (QoR15) questionnaire preoperatively and 24 h postoperatively. DISCUSSION: One patient had a positive sentinel node, the remining were negative. A significant reduction in time spent in hospital post-operatively (p = 0.0008) was observed. QoR15 patient reported outcome measures demonstrated high levels of satisfaction evidenced by lack of statistical difference between pre and post-operative scores (p = 0.0118). 80% of patients were happy to have a regional block and 90% were happy to attend hospital during the pandemic. CONCLUSION: ASNB under regional block is safe, negates risks associated with performing GAs during the COVID-19 pandemic and facilitates quicker theatre turnover and discharge from hospital. Collaboration between anaesthetic and surgical teams has enabled this change in practice. There is a learning curve with both patient selection, education and development of technique.

Free tissue transfer for burns reconstruction: A single-site experience.

This study reviews free tissue transfer (FTT) surgery for both acute wound and reconstructive scar management of burn injuries at a UK burns unit over a 10-year period. Thirty eight patients underwent 46 FTTs, or free flaps, as part of their burn injury pathway. For the cohort of patients, there was one flap failure, which occurred for a secondary scar reconstruction. It is noted that FTT was successful for all seven acute or primary interventions. Anterolateral thigh flap was the most frequently performed (57%); followed by parascapular flaps (22%) of which 43% were pre-expanded. A method of pre-expansion for neck contractures and a novel technique of anchoring this flap to the pre-tracheal fascia are described here. This can provide the patient with good neck contouring by using the capsule to hitch the flap into a good position. It is clear that further work is required to study the prevention of hypertrophic scarring that can occur at the interface between flap and adjacent skin, where occurrence rate in this cohort was 17%. It is proposed that FTT now provides a viable solution both to the coverage of complex burn wounds and to the revision of scar contractures. Consensus over an FTT protocol for the primary management of open burn wounds is seen as the logical next step for this surgical intervention.

The Southwest UK Burns Network (SWUK) experience of electronic cigarette explosions and review of literature.

INTRODUCTION: Since the introduction of e-cigarettes to the UK market in 2007 their popularity amongst young adults has significantly increased. These lithium-ion powered devices remain unregulated by the Standards Agency and as a result burns centres across the world have seen an increasing number of patients presenting with significant burns, resulting from poor quality batteries that appear to be liable to explode when over-heated, over-charged or incorrectly stored. METHODS: Retrospective and perspective review of all e-cigarette related burns presenting to the Southwest Burns Network; South Wales Burns Centre (Morriston Hospital) or to Bristol burns centre (Southmead Hospital) between Oct 15-July 16, followed by a review of available literature performed and eligible papers identified using PRISMA 2009 Checklist. RESULTS: South Wales Burns Centre (Morriston Hospital) (N=5), Bristol burns centre (Southmead Hospital) (N=7). 92% of injuries were seen in male patients with a mean age of 34.58 (±12.7). The mean TSBA sustained 2.54% of mixed depth, most common anatomical area is the thigh 83% (n=10) with a mean 23.1(±5) days to heal with conservative management. The literature search yielded 3 case series (Colaianni et al., 2016; Kumetz et al., 2016; Nicoll et al., 2016) [8,9,12] and 4 case reports (Jablow and Sexton, 2015; Harrison and Hicklin, 2016; Walsh et al., 2016; Shastry and Langdorf, 2016) [6,7,10,11]. We compare our findings with the published studies. CONCLUSION: The import and sale of e-cigarettes remains unrestricted. This increases the risk of devices being available in the UK market that do not meet the British Standard Specification, potentially increasing their risk of causing fire and exploding. Consumers should be made aware of this risk, and advised of adequate charging and storage procedures. In case lithium ion compounds leak following a breach in the battery, first aid with mineral oil use is advocated to avoid a further chemical reaction.