Basosquamous Carcinoma: A Single Centre Clinicopathological Evaluation and Proposal of an Evidence-Based Protocol.

Basosquamous carcinoma (BSC) is an uncommon skin malignancy with significant invasive and metastatic potential. There are currently no clear management guidelines. This study evaluates the management and outcomes of patients diagnosed with BSC over a 7-year period. We present an evidence-based unit protocol for the management of BSC. All patients treated for BSC between 2009 and 2015 were reviewed. Data collected included patient demographics, tumour-specific information, management strategy, presence of recurrence or metastasis, and details of follow-up. 74 patients were identified, making this one of the largest cohorts of BSC patients reported. Mean age at diagnosis was 75.4 years, with a male:female ratio of 1.6:1. The most common tumour site was the head and neck (n=43, 58.1%). All tumours were graded at pT1 (n=51) or pT2 (n=23). Inadequate excision occurred in 17 patients (23%). Mean excision margins were >4mm peripherally and deep. Inadequately excised BSCs were further treated with wide local excision (n=6) or radiotherapy (n=5), or both (n=1). There were no cases of local recurrence or metastatic disease. This study demonstrates a cohort of patients with BSCs that appear less aggressive than previously reported. Current management with surgical excision appears to produce adequate results. However, an evidence-based guideline is still lacking.

Blood flow through sutured and coupled microvascular anastomoses: a comparative computational study.

This study uses computational fluid dynamics (CFD) to model blood flow through idealised sutured and coupled arterial anastomoses to investigate the affect of each technique on intravascular blood flow. Local flow phenomena are examined in detail to study characteristics that potentially initiate thrombus formation; for example, changes in velocity profile, wall shear stress (WSS), and shear strain rate (SSR). Idealised geometries of sutured and coupled anastomoses were created with dimensions identical to microvascular suture material and a commercially available coupling device using CFD software. Vessels were modelled as non-compliant 1 mm diameter ducts, and blood was simulated as a Newtonian fluid, in keeping with previous studies. All analyses were steady-state and performed on arteries. The sutured simulation revealed a reduced boundary velocity profile; high WSS; and high SSR at the suture sites. The coupled anastomosis simulation showed a small increase in maximum WSS at the anastomotic region compared to a pristine vessel, however, this was less than half that of the sutured model. The coupled vessel displayed an average WSS equivalent to a pristine vessel simulation. Taken together these observations demonstrate a theoretically more thrombogenic profile in a sutured anastomosis when compared to a coupled vessel. Data from simulations on a coupled anastomosis reveal a profile that is nearly equivalent to that of a pristine vessel. Based purely on the combination of less favourable flow properties shown using these idealised arterial models, the sutured method is potentially more thrombogenic than a coupled anastomosis.

Practical perioperative pinnaplasty preparation.

Creating and maintaining a sterile operative field for pinnaplasty can be difficult. Drapes can slip, and stray hairs can interfere with delicate dissection and suturing. Methods to combat this have been suggested in the literature, but each has disadvantages, either in cost or in adequacy of surgical access. This report describes a practical and prudent technique for reducing contamination and obstruction by stray hairs in the operative field during performance of a pinnaplasty while maintaining adequate access at no added cost.

CASE REPORT Playing Football Burns More Than Just Calories.

OBJECTIVE: To highlight the case of a sports-related alkali burn due to a common household chemical and emphasize the importance of a detailed medical history in chemical burns patients. METHODS: A single-patient case study is presented along with references from existing literature. RESULTS: Alkaline burn injuries associated with sports have previously been described in the literature; however, this case demonstrates an unusual presentation of a chemical burn with a readily available household substance. CONCLUSION: Chemical burns can present in atypical ways. Detailed history and thorough clinical examination is essential in determining the correct diagnosis and therefore implementing the most appropriate management plan.