Time filter

Source Type

Naderi N.,University of Swansea | Naderi N.,Welsh Center for Burns and Plastic Surgery | Naderi N.,University College London | Griffin M.,University College London | And 6 more authors.
Journal of Biomaterials Applications | Year: 2016

Objective Selection of the appropriate sterilisation method for biodegradable materials has been a challenging task. Many conventional sterilisation methods are not suitable for the next generation of biomaterials, mainly due to their complex composition, based on nanomaterials, often incorporating bioactive moieties. In this study, we investigate sterilisation efficacy of slow chlorine releasing compound sodium dichloroisocyanurate dihydrate (SDIC) for polyhedral oligomeric silsesquioxane (POSS)-poly(caprolactone urea-urethane) (PCL) scaffolds in comparison with conventional sterilisation methods. Methods POSS-PCL scaffolds were subjected to 70% ethanol, UV, and SDIC sterilisation methods. Samples were immersed in tryptone soya broth (TSB) and thioglycollate medium (THY) and after seven days visually inspected for signs of microbial growth. Bulk and surface properties and molecular weight distribution profiles of the scaffolds after sterilization were investigated using FTIR analysis, surface hydrophilicity, scanning electron microscopy analysis, tensile strength testing, and gel-permeation chromatography (GPC). Adipose-derived stem cells (ADSC) were seeded on the scaffolds and AlamarBlue® viability assay was performed to investigate cell metabolic activity. Confocal imaging of rhodamine phalloidin and Dapi stained ADSC on scaffolds was used to demonstrate cell morphology. Results GPC results showed that autoclaving led to a significant decrease in the molecular weight of POSS-PCL, whereas ethanol caused visible deformation of the polymer 3D structure and UV radiation did not effectively sterilise the scaffolds. AlamarBlue® analysis showed metabolic activity close to that of tissue culture plastic for ethanol and SDIC. Conclusion SDIC sterilisation can be safely applied to biodegradable scaffolds unsuitable for the more common sterilisation methods. © 2015 The Author(s).


Naderi N.,Welsh Center for Burns and Plastic Surgery | Maw K.,University of Swansea | Thomas M.,University of Swansea | Boyce D.E.,Welsh Center for Burns and Plastic Surgery | Shokrollahi K.,Whiston Hospital
Annals of the Royal College of Surgeons of England | Year: 2012

Introduction: Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed 'static' posture for several minutes. This is hazardous to theatre staff. Furthermore, 'painting' the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the 'sterile bag' preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists. Methods: We monitored the duration of PLP in 20 patients using the 'sterile bag' technique compared to 20 patients using a conventional 'painting' method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery. Results: The mean duration of the 'sterile bag' PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken. Conclusions: The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.


Ivers R.Q.,University of Sydney | Ivers R.Q.,Flinders University | Hunter K.,University of Sydney | Clapham K.,University of Wollongong | And 20 more authors.
BMJ Open | Year: 2015

Introduction: Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. Methods and analysis: All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; followups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. Ethics and dissemination: The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals.


Agostini T.,University of Florence | Lazzeri D.,Hospital of Cisanello | Agostini V.,University of Florence | Spinelli G.,CTO AOUC | Shokrollahi K.,Welsh Center for Burns and Plastic Surgery
Journal of Craniofacial Surgery | Year: 2012

The incidence of free flap failure is reported at 4% to 5%,but pedicle thrombosis occurs in a higher percentage, with the difference resulting from successful salvage of failing flaps. Often, these failures are attributed to postoperative venous thrombosis with salvage reported at 42%. The venous engorgement of the flap and the resulting microvascular changes lead to a more rapid and less reversible no-reflow phenomenon established within 6 hours. However, this report shows successful free flap salvage with thrombolytic drugs after 6 hours, highlighting that the mechanisms of free flap failure are still poorly understood. Copyright © 2012 by Mutaz B. Habal, MD.


Javed M.,Mersey Center for Burns and Plastic Surgery | Javed M.,Welsh Center for Burns and Plastic Surgery | Shokrollahi K.,Mersey Center for Burns and Plastic Surgery
Burns | Year: 2012

The depth of any burn wound is an important determinant of its management and outcome. It also governs the outcome of wound healing and scarring making initial depth assessment extremely vital. Various methods both invasive and non-invasive have been described in literature for burn depth estimation. We describe a useful adjunct to clinical burn depth assessment, a VACUETTE® venous blood sampling device. This single cheap, ubiquitous and sterile device usually used for phlebotomy allows subjective assessment of the most useful parameters in the assessment of burn wounds, including, capillary refill, evaluation of sensation to blunt and sharp stimuli including pain. © 2012 Elsevier Ltd and ISBI. All rights reserved.


Azzopardi E.A.,University of Cardiff | Azzopardi E.A.,Welsh Center for Burns and Plastic Surgery | Azzopardi S.M.,University of Malta | Boyce D.E.,Welsh Center for Burns and Plastic Surgery | Dickson W.A.,Welsh Center for Burns and Plastic Surgery
Journal of Burn Care and Research | Year: 2011

Gram-negative infection remains a major contributor to morbidity, mortality, and cost of care. In the absence of comparative multinational epidemiological studies specific to burn patients, we sought to review literature trends in emerging Gram-negative burn wound infections within the past 60 years. Mapping trends in these organisms, although in a minority compared with the six "ESKAPE" pathogens currently being targeted by the Infectious Diseases Society of North America, would identify pathogens of increasing concern to burn physicians in the near future and develop patient profiles that may predict susceptibility to infection. Aeromonas hydrophila infection was identified as the emerging pathogen of note, constituting 76% of the identified publications. A. hydrophila constituted 96% of Aeromonas spp. isolates (mortality 10.7%). The following patient profile indicated predisposition to Aeromonas infection: mean age (mean 33.7 years, range 17 ≤ R ≤ 80, SD = 15.6); TBSA (mean 41.1%, range 8% ≤ R ≤ 80%, SD = 15.2); full-thickness skin burns (mean 27.7%, range 3% ≤ R ≤ 60%, SD = 16.6); and a male predominance (81.3%). Other pathogens included Stenotrophomonas maltophilia Vibrio spp., Chryseobacterium spp., Alcaligenes xylosoxidans, and Cedecia lapigei. Arresting the thermal injury by untreated water was the common predisposing factor. These emerging infections clearly constitute a minority of Gram-negative bacterial infections in burn patients at present. However, these are the infections most likely to pose significant clinical challenge because of the high prevalence of multidrug resistance, rapid acquisition of multidrug resistance, high mortality, and ubiquity in the natural environment. This article therefore presents a rationale for understanding and recognizing the role of these emerging infections in burn patients. © 2011 by the American Burn Association.


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.


Sarwar U.,Welsh Center for Burns and Plastic Surgery | Javed M.,Welsh Center for Burns and Plastic Surgery | Rahman S.,Welsh Center for Burns and Plastic Surgery | Wright T.C.,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. Copyright 2014 BMJ Publishing Group. All rights reserved.


PubMed | Welsh Center for Burns and Plastic Surgery
Type: Journal Article | Journal: Annals of the Royal College of Surgeons of England | Year: 2012

Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed static posture for several minutes. This is hazardous to theatre staff. Furthermore, painting the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the sterile bag preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists.We monitored the duration of PLP in 20 patients using the sterile bag technique compared to 20 patients using a conventional painting method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery.The mean duration of the sterile bag PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken.The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.


PubMed | Welsh Center for Burns and Plastic Surgery
Type: | Journal: 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.

Loading Welsh Center for Burns and Plastic Surgery collaborators
Loading Welsh Center for Burns and Plastic Surgery collaborators