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Morriston, United Kingdom

Rozen W.M.,University of Melbourne | Chubb D.,University of Melbourne | Whitaker I.S.,Welsh Center for Burns and Plastic Surgery | Acosta R.,Uppsala University Hospital
Microsurgery | Year: 2010

Background: An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone. Methods: A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook-Swartz implantable Doppler probe. Outcome measures included flap salvage rate and false-positive rate. Results: There was a strong trend toward improved salvage rates with the implantable Doppler probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta-analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false-positive rates. Conclusion: Flap monitoring with the implantable Doppler probe can improve flap salvage rates without increasing the rate of false-positive takebacks. © 2009 Wiley-Liss, Inc. Source


Ricks R.,Welsh Center for Burns and Plastic Surgery
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2010

Tungsten carbide (WC) is an incredibly hard inorganic compound that has recently become fashionable in the manufacture of men's jewellery, particularly wedding rings. It is a common misconception that these rings are unable to be cut and emergency treatment to remove them necessitates the amputation of the finger trapped within. We present a case of such a ring being successfully removed with the use of a diamond tipped dental drill with restoration of function and preservation of the finger. This is a previously undocumented method of removal of this type of ring in the English language literature. © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source


Sarwar U.,Welsh Center for Burns and Plastic Surgery
BMJ case reports | Year: 2014

High-pressure injection (HPI) injuries are an uncommon mechanism of trauma. The clinical effects of the HPI injury depend upon a number of variables including the pressures involved, chemical toxicity, quantity of material injected and its temperature. Evidence within the literature has shown that delay in identifying and treating such injuries can lead to devastating consequences. We describe one such case of a HPI injury involving engine oil to a digit. In addition, we review the clinical course, pathophysiology and management of such injuries. Source


Enajat M.,Uppsala Clinic Hospital | Rozen W.M.,University of Melbourne | Whitaker I.S.,Welsh Center for Burns and Plastic Surgery | Smit J.M.,Uppsala Clinic Hospital | Acosta R.,Uppsala Clinic Hospital
Microsurgery | Year: 2010

Background: Venous complications have been reported as the more frequently encountered vascular complications seen in the transfer of deep inferior epigastric artery (DIEA) perforator (DIEP) flaps, with a variety of techniques described for augmenting the venous drainage of these flaps to minimize venous congestion. The benefits of such techniques have not been shown to be of clinical benefit on a large scale due to the small number of cases in published series. Methods: A retrospective study of 564 consecutive DIEP flaps at a single institution was undertaken, comparing the prospective use of one venous anastomosis (273 cases) to two anastomoses (291 cases). The secondary donor vein comprised a second DIEA venae commitante in 7.9% of cases and a superficial inferior epigastric vein (SIEV) in 92.1%. Clinical outcomes were assessed, in particular rates of venous congestion. Results: The use of two venous anastomoses resulted in a significant reduction in the number of cases of venous congestion to zero (0 vs. 7, P = 0.006). All other outcomes were similar between groups. Notably, the use of a secondary vein did not result in any significant increase in operative time (385 minutes vs. 383 minutes, P = 0.57). Conclusions: The use of a secondary vein in the drainage of a DIEP flap can significantly reduce the incidence of venous congestion, with no detriment to complication rates. Consideration of incorporating both the superficial and deep venous systems is an approach that may further improve the venous drainage of the flap. © 2009 Wiley-Liss, Inc. Source


Marsden N.J.,Welsh Center for Burns and Plastic Surgery | Wilson-Jones N.,Welsh Center for Burns and Plastic Surgery
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Endometriosis is the presence or growth of endometrial tissue outside the uterus, most commonly affecting the ovaries, uterine ligaments and the peritoneum. Cutaneous endometriosis is much rarer, and is mostly found at the sites of surgical scars, such as laparoscopies, hysterectomies and caesarean sections. We present a rare case of scar endometriosis in a 33 year-old women presenting to the plastic surgeon as a possible skin malignancy and review the literature. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source

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