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Sivathasan N.,St Andrews Center for Plastic Surgery and Burns
Emergency Medicine Journal | Year: 2010

Chlorobenzalmalononitrile or 2-chlorobenzylidene malononitrile (CS) is a commonly used riot control agent. Although generally deemed to be safe for this application, it is known that CS can cause a number of adverse effects in those exposed to it. Understanding its properties and its side effects is important in ensuring optimal medical management of its complications and, indeed, this principle applies to every chemical. As the need for CS and other law enforcement devices increases, it is important for the emergency medicine team and other specialties to be aware of correct management protocols.

Maan Z.N.,Imperial College London | Maan Z.N.,St Andrews Center for Plastic Surgery and Burns | Maan I.N.,Kings College London | Darzi A.W.,Imperial College London | Aggarwal R.,Imperial College London
British Journal of Surgery | Year: 2012

Background: Selection criteria for surgical training are not scientifically proven. There is a need to define which attributes predict future surgical performance. The aim of this study was to examine the predictive value of specific attributes that impact on surgical performance. Methods: All studies assessing the predictive power of specified attributes with regard to outcome measures of surgical performance in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Educational Resources Information Centre databases, and bibliographies of selected articles from 1950 to November 2010 were considered for inclusion by two independent reviewers. Information on study identifiers, participant characteristics, predictors assessed, evaluation methods for predictors, outcome measures, results and statistical analysis was collected. Quality assessment was carried out using the Hayden criteria. Results: Visual-spatial perception correlated with both subjective and objective assessments of surgical performance, including rate of skill acquisition. Visual-spatial perception did not correlate with operative ability in experts, although it did with operative ability at the end of a training programme. Psychomotor aptitude, assessed collectively, correlated with rate of skill acquisition. Academic achievement predicted completion of a training programme and passing end-of-training examinations, but did not predict clinical performance during the training programme. Conclusion: Intermediate- and high-level visual-spatial perception, as well as psychomotor aptitude, can be used as criteria for assessing candidates for surgical training. Academic achievement is an effective predictor of successful completion of training programmes and should continue to form part of the assessment of surgical candidates. © 2012 British Journal of Surgery Society Ltd.

Jabir S.,St Andrews Center for Plastic Surgery and Burns
BMJ case reports | Year: 2013

Sciatic nerve palsy following total hip replacement is a rare but serious complication. The neurological sequelae that follow range from pure sensory loss to combined motor and sensory loss involving most of the lower limb. The loss of nociceptive feedback predisposes patients to accidental damage to the lower limb. We present the case of a lady with sciatic nerve palsy who sustained full-thickness burn injuries to her foot via a hot water bottle. The dilemma between debridement and grafting following a recent history of surgical trauma (ie, total hip replacement) versus secondary healing via dressings and regular review is discussed. Although grafting is the standard treatment in such burns, we recommend secondary healing over grafting provided the burns are not extensive. This enables potential recovery of sensation and reduces operative trauma to the limb which may retard resolution of the neuropraxia.

Iwuagwu F.,St Andrews Center for Plastic Surgery and Burns | Siddiqui A.,St Andrews Center for Plastic Surgery and Burns
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

A dictum of reconstruction is to replace like with like. 1 Therefore, glabrous skin is best replaced with like tissue from the palm or the soles of the feet. We have previously presented our experience with free tissue from the palm based on the superficial palmer branch of the radial artery to reconstruct defects on the volar aspect of the digits 2,3 following the original description of this flap by Kamei et al. 4 There are situations where an antegrade pedicled flap from this area lends well as a choice for reconstruction. We describe the use of a pedicled flap from this axis for a defect on the radial aspect of the thumb and we believe it is the first report of its kind. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Soni A.,Leeds General Infirmary | Tzafetta K.,St Andrews Center for Plastic Surgery and Burns | Knight S.,Leeds General Infirmary | Giannoudis P.V.,University of Leeds
Journal of Bone and Joint Surgery - Series B | Year: 2012

Controversy continues to surround the management of patients with an open fracture of the lower limb and an associated vascular injury (Gustilo type IIIC). This study reports our 15- year experience with these fractures and their outcome in 18 patients (15 male and three female). Their mean age was 30.7 years (8 to 54) and mean Mangled Extremity Severity Score (MESS) at presentation was 6.9 (3 to 10). A total of 15 lower limbs were salvaged and three underwent amputation (two immediate and one delayed). Four patients underwent stabilisation of the fracture by external fixation and 12 with an internal device. A total of 11 patients had damage to multiple arteries and eight had a vein graft. Wound cover was achieved with a pedicled flap in three and a free flap in six. Seven patients developed awound infection and four developed nonunion requiring further surgery. At a mean followup of five years (4.1 to 6.6) the mean visual analogue scale for pain was 64 (10 to 90). Depression and anxiety were common. Activities were limited mainly because of pain, and the MESS was a valid predictor of the functional outcome. Distal tibial fractures had an increased rate of nonunion when associated with posterior tibial artery damage, and seven patients (39%) were not able to return to their previous occupation. © 2012 British Editorial Society.

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