R I S Winterton

Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom

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Publications (10)24.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Defects of the perineum are created during ablative procedures for gynaecological, urological and colorectal malignancies. The gluteal fold flap is a reliable means of reconstructing these defects. We retrospectively reviewed case notes of gluteal fold flaps performed for perineal reconstruction over four years (2007-2010) in our institution. 77 perineal defects were reconstructed using unilateral or bilateral gluteal fold flaps (127 flaps in total). 50% of all patients are discharged before 11 days, and 90% were discharged within one month. Mean time to discharge was 13.2 days. 70% of all patients were completely healed at 2 months, and 85% completely healed at three months. Pre-operative radiotherapy was found to have a prolonging effect on the time to discharge (P < 0.05) but did not reach statistical significance when considering the eventual time to healing. The number of co-morbidities that each patient had at the time of surgery had a prolonging effect on both time to discharge and time to healing (P < 0.03). The type of resected areas that required reconstruction did not have a statistically significant effect on the time to discharge, but defects where the anus had been resected did eventually take longer to heal than those were the anus was not resected (P < 0.01). 124 flaps were successful (97.6%) with total or partial flap loss occurring in three. Complications were seen in 34 of the 77 patients (44%), with simple wound breakdown resulting in delayed healing seen most frequently (30%). The gluteal fold fasciocutaneous flap is a versatile option for reconstructing a wide range of pelvic and perineal defects. Patients with multiple co-morbidities, cases with radiotherapy and instances where the anus has been resected are more likely to experience longer healing times. We present our algorithm for management for perineal defects after tumour resection.
    Journal of Plastic Reconstructive & Aesthetic Surgery 10/2012; · 1.44 Impact Factor
  • Plastic and reconstructive surgery 12/2010; 126(6):2296-7; author reply 2297. · 2.74 Impact Factor
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    ABSTRACT: Nasal dermoid sinus cysts (NDSCs) are rare congenital anomalies affecting approximately 1 in 30,000 live births. Nasal dermoid sinus cysts are unsightly, prone to infection, and, importantly, may communicate with the central nervous system. Treatment is complete surgical excision. This study retrospectively evaluated management of a large single-center cohort of intracranial NDSCs.Nineteen patients with NDSC were identified from all patients presenting to the Leeds craniofacial service between June 2000 and August 2008. Patient demographics, clinical presentation, preoperative investigations, and surgical procedures undertaken were analyzed.Mean age at presentation and surgery were 6.3 and 7.6 years, respectively. Fifty-three percent were males. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 15 and 17 patients, respectively. One patient (5.3%) required local excision only. Eighteen (96.7%) underwent a bicoronal approach, and 13 (68.4%) of these required a craniotomy. The dura was opened in 7 (36.8%) patients. Neither CT nor MRI predicted the presence or absence of intracranial extension in all patients. Positive and negative predictive values for intracranial extension were 85.7% and 50% for CT and were 100% and 50.0% for MRI. Mean follow-up of 4.1 years shows no deep recurrences and 5 (26.3%) were superficial nasal recurrences only.A multidisciplinary approach can achieve good results with infrequent intracranial recurrence. We used a bicoronal approach to facilitate craniotomy when required intraoperatively because imaging is unable to diagnose intracranial extension with sufficient accuracy.
    The Journal of craniofacial surgery 02/2010; 21(2):295-300. · 0.81 Impact Factor
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    ABSTRACT: Free tissue transfers must survive in order to achieve their surgical goals. There is little consensus about managing the 'failing' free flap, and practice is often guided by anecdote. We have prospectively collected data about all free flaps performed within our department between 1985 and 2008 (2569 flaps). We identified 327 flaps which were re-explored a total of 369 times. We analysed these flaps with regard to indication for re-exploration, operative findings and outcome. Thirteen percent (327) of free flaps were re-explored. Of these, 291 (83%) had a successful outcome. Successful re-explorations took place at a mean 19h post-op and unsuccessful re-explorations at a mean 56h post-op. Clinical diagnosis prior to re-exploration was confirmed operatively in 91% of cases. We have considered the factors that allowed us to achieve the salvage rates described over a prolonged period, and identified two key areas. Firstly, we favour a model for free flap monitoring with clinical judgement at its core. Secondly, we feel the facility to recover patients post-operatively in a specialised, warmed environment, and return them to theatre quickly should the need arise, is essential. These two simple, yet institutionally determined factors are vital for maintaining excellent success rates.
    Journal of Plastic Reconstructive & Aesthetic Surgery 07/2009; 63(7):1080-6. · 1.44 Impact Factor
  • R M Pinder, A Hart, R I S Winterton, A Yates, S P J Kay
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    ABSTRACT: Experience shows that young children are favourable candidates for microsurgical reconstruction, having few of the established risk factors for flap failure. In children's reconstructive surgery free tissue transfer (FTT) permits reconstruction whilst retaining growth potential, and reduces the overall number and duration of care episodes, and their related distress to the child and family. We present one centre's experience of free tissue transfer in children less than 2 years of age, over a 15-year period, demonstrating that free tissue transfer can be successfully employed in children under 2 years old. Salient aspects of patient selection, pre-operative counselling, and per-operative management are presented. Data from all free flaps in children under 2 years of age at the time of surgery were collected prospectively. Forty-seven flaps were performed as 37 separate procedures, in 32 children under 2 years of age. In ten patients, double transfers were performed in single procedures. Free tissue transfers were performed for reconstruction of congenital defects, following trauma and meningococcal septicaemia. All but one flap survived. In our series operative and ischaemia times, re-exploration, complication and flap failure rates were not higher than in comparable adult or older paediatric series from this unit, suggesting that there is no microvascular, or other, factor inherent to the infant that should preclude the use of free tissue transfer. Individual microsurgeons with appropriate facilities should not be inhibited from performing free tissue transfers which are humane and cost effective when compared with alternatives for very young children.
    Journal of Plastic Reconstructive & Aesthetic Surgery 04/2009; 63(4):616-22. · 1.44 Impact Factor
  • Sara E. Atkins, Robert I. S. Winterton, Simon P. Kay
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    ABSTRACT: This review looks at the history of replantation in the upper limb, and how both survival of the amputated part and functional outcomes have improved with increasing microsurgical experience. We discuss the relevant considerations when part of an upper limb is amputated, and the indications and contraindications to microsurgical replantation. The practicalities of managing this injury that threatens limb, and sometimes life, are highlighted, together with key points from our suggested operative management plan. Finally, we review the current literature with regard to prognosis and functional outcomes that can be achieved when replanting an amputated part of an upper limb.
    Current Orthopaedics - CURR ORTHOPAED. 01/2008; 22(1):31-41.
  • Source
    Article: Minerva
    J E Tomlinson, R I S Winterton, H Peach, J Dunbar
    BMJ Clinical Research 06/2007; · 14.09 Impact Factor
  • R I S Winterton, A Alaani, D Loke, C Bem
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    ABSTRACT: To evaluate the effectiveness of an information leaflet in improving patient understanding of the procedure and complications of septoplasty. The baseline knowledge of a group of patients who had attended a pre-assessment clinic prior to septoplasty was assessed. The procedure and its complications were then verbally explained. The patients' knowledge was then re-assessed on the morning of surgery and any improvements noted. In the second arm of the study, an information leaflet was introduced at the time of verbal instruction and any differences in improvement in knowledge were assessed. Data from the two groups were analysed using an analysis of covariance with differences in baseline (pre-instruction) knowledge controlled. Additional improvements in mean recall score following leaflet distribution were highly statistically significant when compared with mean recall in the control group (p<0.001). The use of information leaflets increases patients' knowledge about a surgical procedure and its potential complications.
    The Journal of Laryngology & Otology 03/2007; 121(2):134-7. · 0.68 Impact Factor
  • James E Tomlinson, Robert I S Winterton, Mark I Liddington
    Journal of Plastic Reconstructive & Aesthetic Surgery 02/2007; 60(10):1164-5. · 1.44 Impact Factor
  • R. I. S. Winterton, I. M. Smith, I. T. H. Foo
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    ABSTRACT: We report a patient in whom we reconstructed a full thickness 95% lower lip defect after excision of a large squamous cell carcinoma. A composite free radial forearm–palmaris longus flap was used with an additional length of palmaris longus tendon to add support to the inferior part of the flap. We believe that this extra bar of palmaris longus graft can add important structure to an otherwise unsupported part of the reconstruction.
    European Journal of Plastic Surgery 01/2007; 29(7):343-346.