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ABSTRACT: All English emergency departments including minor injury units (n=207) were successfully contacted and a telephone questionnaire was completed. This considered wound treatment policy; management including cleansing, analgesia, dressing selection, suturing, referral patterns, medical photography and antibiotic use.
Journal of wound care 09/2012; 21(9):431-8.
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Journal of Plastic Reconstructive & Aesthetic Surgery 04/2011; 64(9):e250-1. · 1.49 Impact Factor
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ABSTRACT: Acute soft tissue wounds are commonly seen in the prehospital setting. It was hypothesised that there is a lack of consistency in early management of trauma wounds, particularly in the dressings used.
In January 2007 a questionnaire-based study was undertaken to evaluate the early management of such injuries. All 13 UK ambulance services were contacted, as well as 2 voluntary ambulance services. The questionnaire considered the implementation of a wound treatment policy and staff training, immediate wound management including haemostasis, cleansing, analgesia, dressings and the use of antibiotics.
The response rate was 100%. Only 27% of services had a wound treatment policy in place, but all services implemented staff training. All services regularly achieved haemostasis of wounds using a combination of pressure and elevation. Regular cleansing was performed by 47% of services and those that did so used normal saline or water. All ambulance services administered analgesics. The most commonly used analgesics were Entonox and intravenous morphine. Other analgesics administered were paracetamol and ibuprofen. No local anaesthesia was used. Dressings were applied regularly by all services; 13 different types of dressings were in regular use.
This study confirmed that there is currently no national standard protocol for early acute wound management in the prehospital care setting. The key areas for improvement are cleansing, simplification of dressings and the introduction of standardised protocols and teaching.
Emergency Medicine Journal 08/2009; 26(7):532-4. · 1.44 Impact Factor
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Case Reports 01/2009; 2009:bcr2006041962.
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Emergency Medicine Journal 12/2007; 24(11):777. · 1.44 Impact Factor
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Burns 09/2007; 33(5):672. · 1.96 Impact Factor
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ABSTRACT: The Specialist Advisory Committee (SAC) in plastic surgery within the United Kingdom (UK) recommends a modular training programme to include aesthetic surgery. The intercollegiate board examinations test candidates on all aspects of aesthetic practice yet there is no formal, national aesthetic training in the UK. Closure of National Health Service (NHS) private patient facilities has reduced training opportunity [Nicolle FV. Sir Harold Gillies Memorial Lecture; Aesthetic plastic surgery and the future plastic surgeon. Br J Plast Surg 1998;51:419-24.] Calmanisation [Hospital doctors: training for the future. The Report of the Working Group on Specialist Medical Training (The Calman Report). London: HMSO; 1993.], the European Working Time Directive (EWTD) [; Phillips H, Fleet Z, Bowman K. The European Working time Directive-interim report and guidance from The Royal College of Surgeons of England working party chaired by Mr Hugh Phillips; 2003 []; Chesser S, Bowman K, Phillips H. The European Working Time Directive and the training of surgeons. BMJ Careers Focus 2002;s69-7.], and more importantly the implementation of "local" aesthetic guidelines have placed further pressures on training. Reductions of NHS case mix will ultimately lead to a reduction in trainee experience. With increasing regulatory pressure from the Commission for Healthcare Improvement, standards of aesthetic practice can only be maintained by increasing private/independent sector involvement. At present a disparity exists between the demand and provision of aesthetic surgery training in the UK. Aesthetic surgery forms part of the training curriculum for plastic surgery and as such remains a training issue. A review of aesthetic surgery training is needed in the UK through consultation with trainers and trainee representatives.
Journal of Plastic Reconstructive & Aesthetic Surgery 02/2006; 59(8):856-9. · 1.49 Impact Factor
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ABSTRACT: The joint British Association of Plastic Surgeons and British Orthopaedic Association (BAPS/BOA) guidelines for the management of patients with open tibia fractures were published in 1991 and 1997 and provided a synopsis of injury epidemiology and best care. We present a retrospective review of 66 patients treated over a 2-year period (January 2001-February 2003) at a regional plastic surgery unit. There were 33 direct admissions and 33 transfers from other hospitals in which the average delay in transfer was 7.8 days (1-28) and in whom 26 (79%) patients had already undergone surgery. Plastic surgeons were involved in 46 (62%) of the 66 patient cohort and 27 (82%) transferred patients. The delay after admission until soft tissue cover was 3.8 days (0-15). Twenty-nine (44%) complications were recorded, 20 (69%) of these were in the transferred group and additional orthopaedic intervention was needed in 11 (42%) of patients who had been operated on in other hospitals. Despite widespread dissemination and teaching of the BAPS/BOA guidelines, complex extremity trauma is often not managed well in our region. There are unacceptable delays in admission, late communication, poor note keeping and follow up. The initial surgery/fixation is often sub-optimal and soft tissue reconstruction has to be considered at the least advantageous time period for the patient, leading to an increased hospital stay and complications.
British Journal of Plastic Surgery 08/2005; 58(5):640-5. · 1.29 Impact Factor
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Journal of the Royal Army Medical Corps 04/2004; 150(1):10-3.
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Burns 12/2003; 29(7):739-44. · 1.96 Impact Factor
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ABSTRACT: Human bites to the ear are not an uncommon injury as a consequence of brawls or even contact sports like rugby. Untreated, the cosmetic outcome of such injury is unsightly. This case history documents how a patient, who had two-thirds of his external ear bitten off, was treated successfully by replacing the part as a composite graft. The segment replanted was minimally trimmed but inset to allow maximal soft tissue apposition at the skin edges. An episode of postoperative venous congestion was treated with leeches. Patience was exercised rather than early debridement of any struggling tissue. All these factors helped the final result, which was 100% take of the replanted segment. Six months from the time of injury, the grafted segment has maintained its shape without cartilage resorption.
British Journal of Plastic Surgery 04/1999; 52(2):152-4. · 1.29 Impact Factor
