Removal of perforated adhesive tape: dry versus solvent-assisted.

This study compared the speed of dry removal of perforated adhesive tape from skin with some of the more commonly used solvents, namely acetone, arachis (peanut) oil, paraffin oil and saline. Twenty healthy volunteers had each of the solvents used on separate adhesive tapes applied circumferentially to their arms. Time to removal was recorded and analysed using the non-parametric sign test. The findings indicate that removing the tape dry was faster than using solvents, with the exception of acetone. Additionally, the researchers had difficulty cleaning the skin following the removal of tape when solvents were used. The solvents tended to cause some disintegration of the tape adhesive, which remained attached to the volunteers' skin and was difficult to remove. The researchers' preference is for dry removal of perforated adhesive tapes.

Comparison of hydrocellular foam and calcium alginate in the healing and comfort of split-thickness skin-graft donor sites.

This is a comparative study of a hydrocellular foam (Allevyn, Smith and Nephew) and a calcium alginate (Kaltostat, ConvaTec) in dressing split-thickness skin-graft donor sites. The dressing materials were used in equal halves of each donor site in 20 patients undergoing skin-graft harvest. The donor sites dressed with Allevyn showed a tendency to earlier healing, but this was not confirmed statistically. However, Allevyn was found to be more comfortable than Kaltostat and this difference was statistically significant. Due to its increased patient comfort, cheaper cost and comparable time to healing with Kaltostat, the authors recommend the use of Allevyn as a dressing for split-thickness skin-graft donor sites.

Diclofenac analgesia following cleft palate surgery.

OBJECTIVE: This prospective study looked at the postoperative hemorrhage risk associated with the use of diclofenac following cleft palate repair. PATIENTS: Twenty consecutive children (6 months to 9 years of age) requiring repair of the hard or soft palate were included. DESIGN AND METHODS: Single per rectum doses of diclofenac were given at 1 mg/kg following cleft palate repair, with additional doses every 12 hours. RESULTS AND CONCLUSIONS: The use of the nonsteroidal anti-inflammatory drug, diclofenac, for postoperative analgesia is well established for many types of surgery. The authors find that twice daily diclofenac rectal suppositories provide very good analgesia postcleft palate repair. This, combined with supplemental oral paracetamol, obviates the need for opiates, resulting in alert infants who feed well and are suitable for early discharge.

Digital blocks with adrenaline. An old dogma refuted.

In the early part of the century, when adrenaline first became widely available, it was used in an uncontrolled manner and cases of ischaemic necrosis led to it falling into disfavour for hand surgery. Local anaesthesia with adrenaline is currently widely used for palmar and dorsal hand surgery but there remains a very deeply ingrained resistance to its use for digital anaesthesia. It is widely thought that it will cause irreversible digital artery vasospasm. This prospective study reports the effect of 2% lignocaine with 1:80,000 adrenaline digital blocks on various parameters of digital arterial blood flow in 100 consecutive patients. Our findings show that adrenaline only temporarily reduced digital blood flow. Perfusion of the digits persisted in every case.

Postoperative infection following clean facial surgery.

Postoperative facial wound infection and breakdown adds to patient morbidity and compromises the cosmetic outcome. This prospective study of 351 patients with a total of 464 wounds for clean elective facial surgery assessed three significant risk factors for wound infection: operative site, oncological surgery, and complex surgery. The findings demonstrated a significantly higher infection rate for the nasal and auricular zones compared with the rest of the face. Wound infection rates were 6.5% for the nasal area, 5% for the auricular area, and 1.5% for the rest of the face. The higher risk of infection to these zones was found to be independent of the lesion excised (benign vs. malignant) and the complexity of the surgery performed. Oncological surgery (skin cancer) and complex surgery (skin grafts and local flaps) were found to increase the risk of postoperative infection significantly by up to fifteenfold compared with nononcological operations with direct closure. The associated morbidity and compromised cosmetic results with facial surgical wound breakdown makes it important to identify these higher risk factors and consider added prophylaxis.

Follow-up requirements for thick cutaneous melanoma.

The primary aim of postoperative melanoma follow-up is the early detection and treatment of treatable recurrences which gives a survival advantage to these patients. The need for follow-up is universally accepted. However, there is ongoing controversy about the duration of follow-up and frequency of reviews. We present a retrospective review of 244 patients with localised thick (> or = 4.0 mm) cutaneous melanoma, who had completed a 10-year follow-up or had died form their melanoma within 10 years. For these criteria, this is the largest series of this type which has been reported to date. The incidence of treatable recurrences peaked in the first postoperative year at 40% and then rapidly decreased, levelling off after year 5 at 2.5% per annum. We believe that this high incidence of treatable recurrences reinforces the need for 10-year follow-up of these patients. We also recommend that the annual frequency of follow-up reviews in each year be based on that year's risk for getting a treatable recurrence. Following this principle, we provide an example of such a follow-up programme.

Early active mobilization for extensor tendon injuries. The Norwich regime.

Dynamic splinting following extensor tendon repair gives better results than static splinting, but involves cumbersome splints and recommended protocols are often complicated. We prefer controlled active mobilization of extensor tendon repairs without dynamic splinting. Six weeks after repair, excellent or good function was obtained in 22 out of 24 simple extensor tendon injuries and in 11 out of 13 complex injuries. The results of this prospective study are comparable with those reported after dynamic splinting; this regime does not require outrigger splintage and is simple to follow.

Staples and gamgee for securing large-area burns dressings.

Securing large area burns dressings can be troublesome and time-consuming. Circumferentially applying gamgee and stapling it to itself was discovered to be easily done, very secure and also had a notably tidy appearance.

A composite lateral arm flap for the secondary repair of a multiply ruptured Achilles tendon.

Reported uses of the lateral arm flap for Achilles tendon reconstruction are few, and all refer to delayed primary repair. We would not only like to suggest its use for secondary repairs but also to recommend the incorporation of a suitable olecranon fragment with the triceps tendon graft as a workable anchoring device. This provides a more secure insetting in the all too common operative situation of a short, frayed distal stump and, most important, helps to insure against postoperative rerupture.