Response to chicco et al. communication entitled 'Management and outcomes of mammalian bite injuries during COVID-19 and implications for future practice' Published: November 07, 2020DOI:https://doi.org/10.1016/j.bjps.2020.10.090.

The Covid-19 pandemic has forced us to treat mammalian bite injuries more conservatively as resources were redirected to the Covid effort resulting in limited availability of hospital beds and theatre space. When comparing our outcomes before and during the first Covid-19 lockdown, this more conservative approach, which resulted in 24% less admissions and 19% less washouts in theatre, did not result in an increased infection rate. An increased rate of bite injuries during the national lockdown period was also noted. We support the conclusion by Chicco et al. that the majority of patients with bite injuries can 'safely be managed with washout under local anaesthesia, oral antibiotics and discharge on the same day with safety net advice'. It is interesting that in some aspects of our care we may find Covid-19 has been beneficial in de-medicalising management of certain injuries and conditions.

Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery-A single-centre double-blinded randomised controlled trial.

BACKGROUND: Electrosurgery makes dissection with simultaneous haemostasis possible. The produced heat can cause injury to the surrounding tissue. The PEAK PlasmaBlade™(PPB) is a new electrosurgery device which may overcome this by having the ability to operate on a lower temperature, therefore reducing collateral thermal damage. METHOD: A single-centre, double-blinded, randomised controlled trial (RCT) was conducted which included 108 abdominal-based free-flap breast reconstruction patients who had their flap raise performed using either the PPB (n = 56) or the conventional diathermy (n = 52). Data were collected during their in-patient stay and out-patient appointments. The primary outcome value was the number of days the abdominal drains were required. RESULTS: Baseline characteristics were similar between the groups, except a significantly lower flap weight in the PPB group. The median number of days the drains were required did not differ significantly (p = 0.48; 6.0 days for the diathermy and 5.0 days for the PPB). The total drain output (p = 0.68), the inflammatory cytokine in the drain fluid (p>0.054) and complications (p>0.24) did not differ significantly between the two groups. At the 2-week follow-up appointment, there was a trend towards less abdominal seromas on abdominal ultrasound (p = 0.09) in the PPB group which were significantly smaller (p = 0.04). CONCLUSION: The use of the PPB did not result in a significant reduction of drain requirement, total drain output or inflammatory cytokines but did reduce the size of seroma collections at the 2-week follow-up appointment. Therefore, the use of the PPB device could reduce early seroma formation after drain removal.

An anatomical study on the effectiveness of Arthrex Mini TightRope® ligament reconstruction in an unstable trapeziometacarpal joint.

INTRODUCTION: Laxity in the trapeziometacarpal (TMC) joint is a debilitating condition usually affecting a young population. It can be treated operatively with ligament reconstruction. The purpose of this study was to determine the effectiveness of the Arthrex Mini TightRope® in reinforcing the stabilizing ligaments in an unstable TMC joint without decreasing the range of motion of the thumb. This method was compared with the "gold standard" published by Eaton and Littler in 1973. MATERIALS AND METHODS: Six fresh frozen arms from five cadavers were included. TMC joint laxity was measured on stress view radiographs as the ratio of the radial subluxation (RS) of the first metacarpal in relation to the trapezium, by the first metacarpal articular width (AW) (as described by Wolf in 2009). Measurements of the pre- and post-operative range of motion (ROM) were performed and compared. RESULTS: Both the Arthrex Mini TightRope® and the Eaton-Littler stabilization improved the stability of the TMC joint. The pre-operative laxity value (ratio RS/AW) of 0.27 was significantly (P = 0.02) improved by each of the surgical interventions (Eaton-Littler RS/AW = 0.05 and Tightrope RS/AW = 0.09). The pre- and post-operative range of motion was not significantly different by each of the surgical interventions. There were no significant differences between the two stabilizing methods regarding laxity or range of motion. CONCLUSION: The Arthrex Mini TightRope® provided a good stabilization method for the TMC joint in this anatomical model without compromising the range of motion.