Plastic surgical operative workload in major trauma patients following establishment of the major trauma network in England: A retrospective cohort study.

INTRODUCTION: The introduction of major trauma centres (MTCs) in England has led to 63% reduction in trauma mortality.(1) The role of plastic surgeons supporting these centres has not been quantified previously. This study aimed to quantify plastic surgical workload at an urban MTC to determine the contribution of plastic surgeons to major trauma care. METHODS: All Trauma Audit and Research Network (TARN)-recorded major trauma patients who presented to an urban MTC in 2013 and underwent an operation were identified retrospectively. Patients who underwent plastic surgery were identified and the type and date of procedure(s) were recorded. The trauma operative workload data of another tertiary surgical specialty and local historical plastics workload data from pre-MTC go-live were collected for comparison. RESULTS: Of the 416 major trauma patients who required surgical intervention, 29% (n = 122) underwent plastic surgery. Of these patients, 43% had open lower limb fractures, necessitating plastic surgical involvement according to British Orthopaedic Association Standards for Trauma (BOAST) 4 guidance. The overall plastic surgery operative workload increased sevenfold post-MTC go-live. A similar proportion of the same cohort required neurosurgery (n = 115; p = 0.589). DISCUSSION: This study quantifies plastic surgery involvement in major trauma and demonstrates that plastic surgical operative workload is at least on par with other tertiary surgical specialties. It also reports one centre's experience of a significant change in plastic surgery activity following designation of MTC status. The quantity of plastic surgical operative workload in major trauma must be considered when planning major trauma service design and workforce provision, and for plastic surgical postgraduate training.

Wound healing assessment using 20 MHz ultrasound and photography.

BACKGROUND/AIMS: To compare two non-invasive techniques of assessing wound healing, photography and high resolution ultrasound (HRUS) scanning, in experimentally induced full-thickness human skin wounds. METHODS: Punch biopsy wounds, 4 mm in diameter, were made aseptically through locally anaesthetised skin on the anterior (volar) surface of the non-dominant forearm, 3 cm below the base of the cubital fossa, of 20 human participants. The wounds were treated with a topical antibiotic and covered for 3 days with Mepore sterile dressings. Wound healing was assessed on post-operative days 3, 7, 14 and 21 from photographs and HRUS B-scans. All photographs were taken of the wound site and adjacent intact skin under standardised conditions. The prints obtained were examined visually and digitised. Digital HRUS B-scans were taken through the centre of the wound bed and the adjacent intact skin parallel to the epidermis. Using the scanner's calibrated linear measurement capability, the wound width was measured adjacent to the deep surface of the scab, at the base of the wound, and midway between these two levels. RESULTS: The wound margins were more clearly defined in the HRUS scans than in the photographs of the wounds; in some of the latter the scab masked the wound margins. Changes in the surface width of the wound were affected by the time of scab dehiscence, which varied between volunteers. There was less individual variation in the width of the base of the wound, as measured from the HRUS scans. CONCLUSIONS: In contrast to photography, which allows recording of changes in the superficial aspect of the wound only, HRUS scanning permits the quantitative assessment of structural changes deep within the wound. Temporal changes in the width of the base of the wound can be used as an indication of the progress of repair.